A comparison of pneumonia care quality between general physicians and pulmonologists

Abstract

BackgroundWe compared the quality of care for nursing‐ and healthcare‐associated pneumonia (NHCAP) and aspiration pneumonia provided by general physicians and pulmonologists.MethodsQuestionnaires were mailed to 2490 medical facilities across Japan. The questionnaire assessed participants’ implementation of microbiological investigations for NHCAP or aspiration pneumonia, as well as steps taken to prevent pneumonia recurrence (eg, use or discontinuation of drugs associated with swallowing and administration of pneumococcal polysaccharides). Survey results were statistically compared between the two groups using chi‐square tests.ResultsWe received responses from 350 hospitals; of those, medical care for aspiration pneumonia was provided by pulmonologists at 190 hospitals and by general physicians at 79 hospitals. No significant differences were observed between the two groups of physicians for any of the items regarding proactive microbiological investigations or measures for preventing pneumonia recurrence. However, general physicians tended to be more proactive in conducting Gram's stains for sputum, sputum culture inspections, and blood culture tests. They also were more likely to implement measures for preventing pneumonia recurrence such as striving to increase patients’ consciousness levels, reducing medication doses, and discontinuing drugs that cause difficulty with swallowing (response rates of “is done in nearly all cases” were 73.4%, 88.6%, 36.7%, 35.4%, and 40.5%, respectively).ConclusionsThe quality of care provided by general physicians may be on par with pulmonologists in terms of proactive microbiological investigations and preventing pneumonia recurrence.

Comparing Outcomes of Community-Acquired Pneumonia Patients Discharged from General Medicine and Respiratory Units in Australia: A Propensity Score-Matched Analysis

“…Our findings suggest that the care provided to non-COVID-19 CAP patients admitted under GM units was more efficient compared to those admitted under Respiratory units. Consistent with previous studies [2,8] our results indicate that there was no compromise in the quality of care for GM patients, as evidenced by comparable in-hospital mortality and 30-day readmission rates between the two units. Prior research has demonstrated that a shorter LOS for CAP patients is associated with reduced healthcare costs [24].…”

“…Limited evidence exists regarding the characteristics and outcomes of CAP patients admitted under generalist versus respiratory care. Some studies have suggested comparable outcomes [2,8], while others [9] have indicated potential benefits, such as reduced mortality and shorter LOS, associated with admission to Respiratory units. These benefits may stem from expedited antibiotic initiation, use of adjunctive therapies such as corticosteroids and early use of fibre optic bronchoscopy which can aid in early pathogen detection [9].…”

Comparing Outcomes of Community-Acquired Pneumonia Patients Discharged from General Medicine and Respiratory Units in Australia: A Propensity Score-Matched Analysis

“…Our findings suggest that the care provided to non-COVID-19 CAP patients admitted under GM units was more efficient compared to those admitted under Respiratory units. Consistent with previous studies [6,12], our results indicate that there was no compromise in the quality of care for GM patients, as evidenced by comparable in-hospital mortality and 30-day readmission rates between the two units. Prior research has demonstrated that a shorter LOS for CAP patients is associated with reduced healthcare costs [27].…”

“…Limited evidence exists regarding the characteristics and outcomes of CAP patients admitted under generalist versus respiratory care. Some studies have suggested comparable outcomes [6,12], while others [13] have indicated potential benefits, such as reduced mortality and shorter LOS, associated with admission to Respiratory units. These benefits may stem from expedited antibiotic initiation, the use of adjunctive therapies such as corticosteroids, and the early use of fibre optic bronchoscopy which can aid in early pathogen detection [13].…”