title: Clinical Pathway and Monthly Feedback Improve Adherence to Antibiotic Guideline Recommendations for Community-Acquired Pneumonia.
abstract: BACKGROUND
  Compliance with community-acquired pneumonia (CAP) guidelines remains poor despite a substantial body of evidence indicating that guideline-concordant care improves patient outcomes. The aim of this study was to compare the relative effectiveness of a general educational and a targeted emergency department intervention on improving physicians' concordance with CAP guidelines.
  
  
  METHODS
  Two distinct interventions were implemented over specific time periods. The first intervention was educational, focusing on the development of local CAP guidelines and their dissemination through hospital-wide educational programmes. The second intervention was a targeted one for the emergency department, where a clinical pathway for the initial management of CAP patients was introduced, followed by monthly feedback to the emergency department (ED) physicians about concordance rates with the guidelines. Data on the concordance rate to CAP guidelines was collected from a retrospective chart review.
  
  
  RESULTS
  A total of 398 eligible patient records were reviewed to measure concordance to CAP guidelines over the study period. Concordance rates during the baseline and educational intervention periods were similar (28.1% vs. 31.2%; p > 0.05). Significantly more patients were treated in accordance with the CAP guidelines after the ED focused intervention when compared to the baseline (61.5% vs. 28.1%; p < 0.05) or educational period (61.5% vs. 31.2%; p < 0.05).
  
  
  CONCLUSIONS
  A targeted intervention with a CAP clinical pathway and monthly feedback was a successful strategy to increase adherence to empirical antibiotic recommendations in CAP guidelines.
authors.affiliation: Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Maher
authors.initials: M
authors.lastname: Almatar
authors.affiliation: Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Peterson
authors.affiliation: Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Angus
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: McKenzie
authors.affiliation: Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: Tara
authors.initials: T
authors.lastname: Anderson
authors.affiliation: Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Syed Tabish R
authors.initials: ST
authors.lastname: Zaidi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015897:Comorbidity; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D005260:Female; D000068156:Formative Feedback; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D063868:Patient Outcome Assessment; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents