Audit of Physicians’ Adherence: METHODS

Study Design and Participants

For this retrospective, observational chart review, patients at least 18 years of age who had been admitted between November 1, 2007, and February 29, 2008, and for whom a diagnosis of pneumonia was recorded on the discharge summary were considered for inclusion.

Patients were included if treatment for pneumonia had been initiated during the hospital stay and if none of the exclusion criteria (which targeted patients without community-acquired pneumonia) were present.

The following exclusion criteria were intended to exclude patients without true community-acquired pneumonia: re- admission within 7 days of a previous admission, dialysis therapy (which requires multiple admissions), residence in a nursing home, and diagnosis of pneumonia more than 72 h after admis­sion. Patients with cystic fibrosis, HIV/AIDS, tuberculosis, and aspiration pneumonia, as well as those undergoing active chemotherapy and those who had undergone transplantation, were also excluded, because treatment for any of these condi­tions might necessitate deviations from standard management of community-acquired pneumonia. Apcalis Oral Jelly

Data Collection

Patients were identified with the help of the medical records department, which used codes from the International Statistical Classification of Diseases and Related Health Problems, 10 th revision, to identify patients who had been admitted with pneumonia; patients less than 18 years old were excluded. One of the investigators (C.T.F.) reviewed each patient record for exclusion criteria and collected pertinent data for eligible patients.

The appropriateness of levofloxacin use in relation to the institution’s recommendations was evaluated by estimating the information available to the prescriber at the time the antibiotic or antibiotics were prescribed. Because of concerns that the information available in each health care record would be insuf­ficient to calculate the pneumonia severity index for patients for whom the preprinted order had not been used, the CURB- 65 score (based on Confusion, Urea nitrogen, Respiratory rate, Blood pressure, and 65 years of age and older) was calculated for all patients, to allow comparison of severity of illness between the 2 populations (with and without use of preprinted orders). In addition, it was anticipated that prescribers who had not used the preprinted order would not have documented the pneumonia severity index separately.

Statistical Analysis

An a priori power analysis was not performed, nor were additional statistics defined a priori, as the initial plan was to use descriptive statistics to reveal prescribing patterns. However, after the study was initiated, the investigators decided that it would be worthwhile to perform a statistical analysis to properly assess the effect of the preprinted order.
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The primary outcome of adherence to the preprinted order was reported with descriptive statistics, as planned. Statistical analyses not defined a priori included a 2-way contingency table analysis using Pearson x2 analysis to evaluate whether there was a statistically significant relationship between use of the preprinted order and use of medications as indicated. In addition, the x2 for independence was used to investigate the relationship between use of the preprinted order and adherence to clinical practice guidelines.

Additional tests not defined a priori were an independent- sample t test comparing length of stay between patients who received treatment according to the preprinted order and patients whose treatment did not involve use of the preprinted order. A one-way analysis of variance (ANOVA) was used to compare the effect of 3 drug regimens on patients’ recovery (as measured by length of stay). Finally, an independent-sample t test was conducted to compare the length of stay between patients who received levofloxacin intravenously and those who received this drug orally.

Category: Drug

Tags: guidelines, levofloxacin, microbial susceptibility, pneumo­nia severity index, pneumonia, vaccination

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