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.
    Full-text · Article · Mar 2015 · Journal of Evaluation in Clinical Practice
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    ABSTRACT: OBJECTIVES: The purpose of our study was to compare community-acquired pneumonia (CAP) patients who were and were not administered treatment in accordance with the Turkish Thoracic Society (TTS) 2009 pneumonia guideline in terms of hospital stay length, treatment cost, and treatment efficacy. MATERIAL AND METHODS: Patients who were admitted to our hospital and who were diagnosed with CAP were included in the study. Demographic characteristics of the patients, symptoms at the time of diagnosis, physical examination, laboratory and radiological findings, treatments, response to treatment at follow-up, length of hospital stay, and direct cost of treatment were recorded in the TTS pneumonia database (TURCAP: TURKEY Community Acquired Pneumonia). Taking into consideration the “Turkish Thoracic Society Consensus Report on the Diagnosis and Treatment of Community-acquired pneumonia in Adults (2009),” the patients recorded in the database were evaluated in terms of conformity to the guideline. RESULTS: This present study included 156 patients diagnosed with CAP. Sixty-six patients (42.3%) were females, and 96 (57.7%) were males, and the mean age of the patients was 70.4 years. The most common symptoms on admission were cough (94.9%), expectoration of purulent sputum (77.6%), and fever (58%). Comorbid diseases were chronic obstructive pulmonary disease (COPD; 29.5%), asthma (3.2%), lung cancer (8.3%), cardiovascular diseases (32.7%), and diabetes mellitus (12.8%). It was observed that 67.3% of the patients received treatment in accordance with the guideline. No significant difference was found in terms of gender and symptoms between the groups that received and did not receive treatment in accordance with the guideline. The mean age of the patients who received treatment according to the guideline was higher than that of the patients who did not receive treatment according to the guideline; COPD was more frequent in the group of patients who received treatment according to the guideline. Pneumonia Severity Index and Confusion, Urea, Respiratory rate, Blood pressure-Age>65 scores of the patients who were treated according to the guideline was higher and treatment resulted in death in 8% of these patients. CONCLUSION: Hospital stay length, treatment cost, and treatment efficacy were similar in patients who were and were not administered treatment in accordance with the guideline.
    No preview · Article · Apr 2015
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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.
    Full-text · Article · Dec 2015 · BMC Pulmonary Medicine
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