An audit of inpatient management of community-acquired pneumonia in Oman: A comparison with regional clinical guidelines

Royal Hospital, Muscat, Oman.
Journal of infection and public health 06/2012; 5(3):250-6. DOI: 10.1016/j.jiph.2012.03.002
Source: PubMed


Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Herein, we present the findings from an audit of CAP management at a tertiary hospital in Oman. The main objective was to evaluate the quality of care given to patients and compare it with the standards in the Gulf Cooperation Council (GCC) CAP guidelines.
A retrospective case study of all patients admitted with CAP from June 2006 to September 2008 examined the adherence to standards for the diagnosis, investigation, and management of CAP, including the documentation of illness severity.
The case notes of 342 patients were reviewed. Of these, 170 patients were excluded from the study, and 172 patients met the diagnostic criteria for inclusion. A CURB-65 severity score was documented for only 4 (2.3%) patients, and a smoking history was documented for 56 (32.6%) patients. Although 17 different antibiotic regimens were used, 115 (67%) patients received co-amoxiclav and clarithromycin, which is the standard of care. Additionally, 139 (81%) patients received their first dose of antibiotics within four hours of hospital admission. There was no documentation of offering influenza or pneumococcal vaccine to high risk patients.
The clinical coding of CAP diagnosis was poor. There was very poor adherence to the CAP severity assessment and the provision of preventive measures upon hospital discharge. The development and implementation of a local hospital-based integrated care pathway may lead to more successful implementation of the guidelines.

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    ABSTRACT: Our aim was to examine and describe the current situation in Gulf Cooperation Council (GCC) member countries regarding the development, implementation and evaluation of clinical practice guidelines (CPG). The objectives were to describe from where the studies originated, what the clinical focus was of each study and examine the methodology and the status of each study (i.e. development, dissemination, implementation and evaluation). Review of literature - two stages: stage 1: screening through an abstract review, followed by independent adjudicator; stage 2: detailed assessment and classification. Considering the widespread acceptance that CPG's are useful and effective tools for quality improvement in health care, it is worth noting that relatively few studies have been conducted in the GCC region that examine CPG. Furthermore, the reviewers found that the quality of the research methods used could be improved. The majority of the studies that were conducted evaluated the effects of guidelines and focused on the 'lifestyle diseases', in particular diabetes and cardiovascular diseases. It is also worth noting that there has been a steady increase in the number of publications over the 10 years period. More attention needs to be given to developing, disseminating, implementing and evaluating CPG's in the GCC region in order to improve the quality and safety of health care. © 2015 John Wiley & Sons, Ltd.
    Journal of Evaluation in Clinical Practice 03/2015; DOI:10.1111/jep.12337 · 1.08 Impact Factor
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    ABSTRACT: Background: Very few data exist on the management of community-acquired pneumonia (CAP) in patients admitted to hospitals in the Gulf region. The objectives of this study were to describe treatment patterns for CAP in 38 hospitals in five Gulf countries (United Arab Emirates, Kuwait, Bahrain, Oman, and Qatar) and to compare the findings to the most recent Infectious Diseases Society of America (IDSA) / American Thoracic Society (ATS) guidelines. Methods: This was a prospective, observational study conducted between January 2009 and February 2011. Adult patients hospitalised (excluding intensive care units) for CAP and subsequently discharged were included. Data were collected retrospectively at hospital discharge, and prospectively during two follow-up visits. Data on medical history, mortality-risk scores, diagnostic criteria, antibiotic treatment, isolated pathogens and clinical and radiographic outcomes were collected. Care practices were compared to the IDSA/ATS guidelines. Results: A total of 684 patients were included. The majority (82.9%) of patients were classified as low risk for mortality (pneumonia severity index II and III). The majority of patients fulfilled criteria for treatment success at discharge, although only 77.6% presented a normalised leukocyte count. Overall, the management of CAP in Gulf countries is in line with the IDSA/ATS guidelines. This applied to the diagnosis of CAP, to the identification of high-risk CAP patients, to the identification of etiologic agent responsible for CAP and to the type of treatment despite the fact that combinations of antimicrobial agents were not consistent with the guidelines in 10% of patients. In all patients, information about Gram's staining was not captured as recommended by the IDSA/ATS and in the majority of patients (>85%) chest radiography was not systematically performed at the post-discharge follow-up visits. Discussion: The management of CAP in the Gulf region is globally in line with current IDSA/ATS guidelines, although rates of pathogen characterisation and post-discharge follow-up need to be improved. Conclusion: Compliance with established guidelines should be encouraged in order to improve the management of the disease in this region.
    BMC Pulmonary Medicine 12/2015; 15(1). DOI:10.1186/s12890-015-0108-x · 2.40 Impact Factor

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