Compliance with guidelines-recommended processes in pneumonia: impact of health status and initial signs.
Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose <6 hours and oxygen assessment. Antibiotic adherence was 72.6%, first dose <6 h was 73.4% and oxygen assessment was 90.2%. Antibiotic adherence was negatively associated with a high Charlson score (Odds ratio [OR], 0.91), confusion (OR, 0.66) and tachycardia ≥100 bpm (OR, 0.77). Delayed first dose was significantly lower in those with tachycardia (OR, 0.75). Initial oxygen assessment was negatively associated with fever (OR, 0.61), whereas tachypnea ≥30 (OR, 1.58), tachycardia (OR, 1.39), age >65 (OR, 1.51) and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care.
Servicio de Neumología, Hospital Universitario y politecnico La Fe, CIBERES, Valencia, Spain. rosmenend@gmail.com
Rosario
R
Menéndez
Antoni
A
Torres
Soledad
S
Reyes
Rafael
R
Zalacain
Alberto
A
Capelastegui
Olga
O
Rajas
Luis
L
Borderías
Juan J
JJ
Martín-Villasclaras
Salvador
S
Bello
Inmaculada
I
Alfageme
Felipe Rodríguez
FR
de Castro
Jordi
J
Rello
Luis
L
Molinos
Juan
J
Ruiz-Manzano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006304:Health Status; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013030:Spain; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents