Empirical management of community-acquired pneumonia: impact of concurrent A/H1N1 influenza pandemic on guideline implementation.
Identifieur interne : 000063 ( Main/Corpus ); précédent : 000062; suivant : 000064Empirical management of community-acquired pneumonia: impact of concurrent A/H1N1 influenza pandemic on guideline implementation.
Auteurs : Pieter-Jan Cortoos ; Christa Gilissen ; Peter G M. Mol ; Filip Van Den Bossche ; Steven Simoens ; Ludo Willems ; Hilde Leenaers ; Ludo Vandorpe ; Willy E. Peetermans ; Gert LaekemanSource :
- The Journal of antimicrobial chemotherapy [ 1460-2091 ] ; 2011.
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Belgium (epidemiology), Community-Acquired Infections (diagnosis), Community-Acquired Infections (drug therapy), Female, Guideline Adherence (statistics & numerical data), Health Services Research, Hospitals, Humans, Influenza, Human (complications), Influenza, Human (epidemiology), Male, Middle Aged, Pandemics, Pneumonia, Bacterial (diagnosis), Pneumonia, Bacterial (drug therapy).
- MESH :
- geographic , epidemiology : Belgium.
- complications : Influenza, Human.
- diagnosis : Community-Acquired Infections, Pneumonia, Bacterial.
- drug therapy : Community-Acquired Infections, Pneumonia, Bacterial.
- epidemiology : Influenza, Human.
- statistics & numerical data : Guideline Adherence.
- Aged, Aged, 80 and over, Female, Health Services Research, Hospitals, Humans, Male, Middle Aged, Pandemics.
Abstract
BACKGROUND
Guideline-concordant therapies have been proven to be associated with improved health and economic outcomes in the treatment of community-acquired pneumonia (CAP). However, actual use of CAP guidelines remains poor, but using tailored interventions looks promising. Based on local observations, we assessed the impact of low-intensity interventions to improve guideline use.
METHODS
Pre-and post-intervention study with segmented regression analysis in a large tertiary care centre [University Hospitals Leuven (UZL)] and a smaller secondary care control hospital [Ziekenhuis Oost-Limburg (ZOL)] from October 2007 through to June 2010 in Belgium.
RESULTS
A total of 477 patients were included in UZL, with 58.5% of the patients treated according to local guidelines. Guideline adherence remained stable, but a decrease (-28.6%; P = 0.021) was observed during guideline re-introduction in October 2009. Further analysis showed a high correlation with the concurrent A/H1N1 influenza pandemic (r(point-biserial) = 0.683; P = 0.045) and with suspected influenza infection (odds ratio = 2.70; P = 0.038). In ZOL, 326 patients were enrolled, with 69.3% being treated concordantly. A similar, non-significant decrease in guideline adherence was observed after October 2009.
CONCLUSIONS
Our interventions did not lead to a higher proportion of CAP patients receiving guideline-compliant therapy. Instead, a compliance decrease was observed, coinciding with the peak in the A/H1N1 pandemic in the population. Similar observations could be made in ZOL. The widespread attention for this pandemic may have altered the perception of needed antibiotic therapy for pulmonary infections, bypassing our interventions and decreasing actual guideline compliance. Increased vigilance and follow-up is needed when epidemics with similar impact occur in the future.
DOI: 10.1093/jac/dkr366
PubMed: 21926079
Links to Exploration step
pubmed:21926079Le document en format XML
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Mol</name></author><author><name sortKey="Van Den Bossche, Filip" sort="Van Den Bossche, Filip" uniqKey="Van Den Bossche F" first="Filip" last="Van Den Bossche">Filip Van Den Bossche</name></author><author><name sortKey="Simoens, Steven" sort="Simoens, Steven" uniqKey="Simoens S" first="Steven" last="Simoens">Steven Simoens</name></author><author><name sortKey="Willems, Ludo" sort="Willems, Ludo" uniqKey="Willems L" first="Ludo" last="Willems">Ludo Willems</name></author><author><name sortKey="Leenaers, Hilde" sort="Leenaers, Hilde" uniqKey="Leenaers H" first="Hilde" last="Leenaers">Hilde Leenaers</name></author><author><name sortKey="Vandorpe, Ludo" sort="Vandorpe, Ludo" uniqKey="Vandorpe L" first="Ludo" last="Vandorpe">Ludo Vandorpe</name></author><author><name sortKey="Peetermans, Willy E" sort="Peetermans, Willy E" uniqKey="Peetermans W" first="Willy E" last="Peetermans">Willy E. Peetermans</name></author><author><name sortKey="Laekeman, Gert" sort="Laekeman, Gert" uniqKey="Laekeman G" first="Gert" last="Laekeman">Gert Laekeman</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2011">2011</date><idno type="RBID">pubmed:21926079</idno><idno type="pmid">21926079</idno><idno type="doi">10.1093/jac/dkr366</idno><idno type="wicri:Area/Main/Corpus">000063</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000063</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Empirical management of community-acquired pneumonia: impact of concurrent A/H1N1 influenza pandemic on guideline implementation.</title><author><name sortKey="Cortoos, Pieter Jan" sort="Cortoos, Pieter Jan" uniqKey="Cortoos P" first="Pieter-Jan" last="Cortoos">Pieter-Jan Cortoos</name><affiliation><nlm:affiliation>Research Centre for Pharmaceutical Care & Pharmaco-economics, Catholic University Leuven, Leuven, Belgium. pieterjan.cortoos@gmail.com</nlm:affiliation></affiliation></author><author><name sortKey="Gilissen, Christa" sort="Gilissen, Christa" uniqKey="Gilissen C" first="Christa" last="Gilissen">Christa Gilissen</name></author><author><name sortKey="Mol, Peter G M" sort="Mol, Peter G M" uniqKey="Mol P" first="Peter G M" last="Mol">Peter G M. Mol</name></author><author><name sortKey="Van Den Bossche, Filip" sort="Van Den Bossche, Filip" uniqKey="Van Den Bossche F" first="Filip" last="Van Den Bossche">Filip Van Den Bossche</name></author><author><name sortKey="Simoens, Steven" sort="Simoens, Steven" uniqKey="Simoens S" first="Steven" last="Simoens">Steven Simoens</name></author><author><name sortKey="Willems, Ludo" sort="Willems, Ludo" uniqKey="Willems L" first="Ludo" last="Willems">Ludo Willems</name></author><author><name sortKey="Leenaers, Hilde" sort="Leenaers, Hilde" uniqKey="Leenaers H" first="Hilde" last="Leenaers">Hilde Leenaers</name></author><author><name sortKey="Vandorpe, Ludo" sort="Vandorpe, Ludo" uniqKey="Vandorpe L" first="Ludo" last="Vandorpe">Ludo Vandorpe</name></author><author><name sortKey="Peetermans, Willy E" sort="Peetermans, Willy E" uniqKey="Peetermans W" first="Willy E" last="Peetermans">Willy E. Peetermans</name></author><author><name sortKey="Laekeman, Gert" sort="Laekeman, Gert" uniqKey="Laekeman G" first="Gert" last="Laekeman">Gert Laekeman</name></author></analytic><series><title level="j">The Journal of antimicrobial chemotherapy</title><idno type="eISSN">1460-2091</idno><imprint><date when="2011" type="published">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Belgium (epidemiology)</term><term>Community-Acquired Infections (diagnosis)</term><term>Community-Acquired Infections (drug therapy)</term><term>Female</term><term>Guideline Adherence (statistics & numerical data)</term><term>Health Services Research</term><term>Hospitals</term><term>Humans</term><term>Influenza, Human (complications)</term><term>Influenza, Human (epidemiology)</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Pneumonia, Bacterial (diagnosis)</term><term>Pneumonia, Bacterial (drug therapy)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Belgium</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Community-Acquired Infections</term><term>Pneumonia, Bacterial</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Community-Acquired Infections</term><term>Pneumonia, Bacterial</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Guideline Adherence</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Health Services Research</term><term>Hospitals</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Guideline-concordant therapies have been proven to be associated with improved health and economic outcomes in the treatment of community-acquired pneumonia (CAP). However, actual use of CAP guidelines remains poor, but using tailored interventions looks promising. Based on local observations, we assessed the impact of low-intensity interventions to improve guideline use.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Pre-and post-intervention study with segmented regression analysis in a large tertiary care centre [University Hospitals Leuven (UZL)] and a smaller secondary care control hospital [Ziekenhuis Oost-Limburg (ZOL)] from October 2007 through to June 2010 in Belgium.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>A total of 477 patients were included in UZL, with 58.5% of the patients treated according to local guidelines. Guideline adherence remained stable, but a decrease (-28.6%; P = 0.021) was observed during guideline re-introduction in October 2009. Further analysis showed a high correlation with the concurrent A/H1N1 influenza pandemic (r(point-biserial) = 0.683; P = 0.045) and with suspected influenza infection (odds ratio = 2.70; P = 0.038). In ZOL, 326 patients were enrolled, with 69.3% being treated concordantly. A similar, non-significant decrease in guideline adherence was observed after October 2009.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Our interventions did not lead to a higher proportion of CAP patients receiving guideline-compliant therapy. Instead, a compliance decrease was observed, coinciding with the peak in the A/H1N1 pandemic in the population. Similar observations could be made in ZOL. The widespread attention for this pandemic may have altered the perception of needed antibiotic therapy for pulmonary infections, bypassing our interventions and decreasing actual guideline compliance. Increased vigilance and follow-up is needed when epidemics with similar impact occur in the future.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">21926079</PMID><DateCompleted><Year>2012</Year><Month>03</Month><Day>01</Day></DateCompleted><DateRevised><Year>2011</Year><Month>11</Month><Day>15</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1460-2091</ISSN><JournalIssue CitedMedium="Internet"><Volume>66</Volume><Issue>12</Issue><PubDate><Year>2011</Year><Month>Dec</Month></PubDate></JournalIssue><Title>The Journal of antimicrobial chemotherapy</Title><ISOAbbreviation>J. Antimicrob. Chemother.</ISOAbbreviation></Journal><ArticleTitle>Empirical management of community-acquired pneumonia: impact of concurrent A/H1N1 influenza pandemic on guideline implementation.</ArticleTitle><Pagination><MedlinePgn>2864-71</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1093/jac/dkr366</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Guideline-concordant therapies have been proven to be associated with improved health and economic outcomes in the treatment of community-acquired pneumonia (CAP). However, actual use of CAP guidelines remains poor, but using tailored interventions looks promising. Based on local observations, we assessed the impact of low-intensity interventions to improve guideline use.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Pre-and post-intervention study with segmented regression analysis in a large tertiary care centre [University Hospitals Leuven (UZL)] and a smaller secondary care control hospital [Ziekenhuis Oost-Limburg (ZOL)] from October 2007 through to June 2010 in Belgium.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">A total of 477 patients were included in UZL, with 58.5% of the patients treated according to local guidelines. Guideline adherence remained stable, but a decrease (-28.6%; P = 0.021) was observed during guideline re-introduction in October 2009. Further analysis showed a high correlation with the concurrent A/H1N1 influenza pandemic (r(point-biserial) = 0.683; P = 0.045) and with suspected influenza infection (odds ratio = 2.70; P = 0.038). In ZOL, 326 patients were enrolled, with 69.3% being treated concordantly. A similar, non-significant decrease in guideline adherence was observed after October 2009.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Our interventions did not lead to a higher proportion of CAP patients receiving guideline-compliant therapy. Instead, a compliance decrease was observed, coinciding with the peak in the A/H1N1 pandemic in the population. Similar observations could be made in ZOL. The widespread attention for this pandemic may have altered the perception of needed antibiotic therapy for pulmonary infections, bypassing our interventions and decreasing actual guideline compliance. Increased vigilance and follow-up is needed when epidemics with similar impact occur in the future.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cortoos</LastName><ForeName>Pieter-Jan</ForeName><Initials>PJ</Initials><AffiliationInfo><Affiliation>Research Centre for Pharmaceutical Care & Pharmaco-economics, Catholic University Leuven, Leuven, Belgium. pieterjan.cortoos@gmail.com</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gilissen</LastName><ForeName>Christa</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Mol</LastName><ForeName>Peter G M</ForeName><Initials>PG</Initials></Author><Author ValidYN="Y"><LastName>Van den Bossche</LastName><ForeName>Filip</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Simoens</LastName><ForeName>Steven</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Willems</LastName><ForeName>Ludo</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Leenaers</LastName><ForeName>Hilde</ForeName><Initials>H</Initials></Author><Author ValidYN="Y"><LastName>Vandorpe</LastName><ForeName>Ludo</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Peetermans</LastName><ForeName>Willy E</ForeName><Initials>WE</Initials></Author><Author ValidYN="Y"><LastName>Laekeman</LastName><ForeName>Gert</ForeName><Initials>G</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2011</Year><Month>09</Month><Day>15</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J Antimicrob Chemother</MedlineTA><NlmUniqueID>7513617</NlmUniqueID><ISSNLinking>0305-7453</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001530" MajorTopicYN="N" Type="Geographic">Belgium</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017714" MajorTopicYN="N">Community-Acquired Infections</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D019983" MajorTopicYN="N">Guideline Adherence</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006302" MajorTopicYN="N">Health Services Research</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006761" MajorTopicYN="N">Hospitals</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018410" MajorTopicYN="N">Pneumonia, Bacterial</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2011</Year><Month>9</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2011</Year><Month>9</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2012</Year><Month>3</Month><Day>2</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">21926079</ArticleId><ArticleId IdType="pii">dkr366</ArticleId><ArticleId IdType="doi">10.1093/jac/dkr366</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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