Physicians' Attitudes Toward Guidelines for the Treatment of Hospitalized Nursing Home–Acquired Pneumonia

El-Solh, Ali; Alhajhusain, Ahmad; Saliba, Ranime; Drinka, Paul J.

doi:10.1016/j.jamda.2010.02.021

Cited by 11 publications

(10 citation statements)

References 24 publications

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“…Junior physicians are known to have positive attitudes toward CPGs, and they report higher adherence rates 3. However, our study showed the opposite, which could be due to the fact that the majority of our senior physicians have prior experience in Western countries where CPGs are commonly used.…”

Section: Discussioncontrasting

confidence: 64%

“…There was no incentive for subjects to participate, and no reminders were supplied. The questionnaire content was based on previous surveys2,3 but adapted to Qatari’s system and modified for the purposes of our study. The questionnaire was composed of two sections and a total of 16 items.…”

Section: Methodsmentioning

confidence: 99%

“…They should be predicated upon the best feasible research evidence and practice experience 1. They are usually described as “systematically developed statements to assist practitioners and patients’ decisions about appropriate health care for specific circumstances” 2,3…”

Section: Introductionmentioning

confidence: 99%

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Pediatricians’ perceptions of clinical practice guidelines

Hendaus¹,

Alhammadi²,

Razig³

et al. 2014

JMDH

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BackgroundClinical practice guidelines (CPGs) are propositions for health care providers about the care of patients and are usually described as “systematically developed statements to assist practitioners’ and patients’ decisions about appropriate health care for specific circumstances”.ObjectivesThe purpose of this study was to investigate pediatricians’ perceptions of clinical practice guidelines at Hamad Medical Corporation (HMC) in Qatar.MethodsA cross-sectional study was conducted at HMC between May 1 and August 31, 2013 using a self-administered questionnaire that was distributed to 240 pediatricians.ResultsA total of 169/240 questionnaires were completed for a response rate of 70.4%. Our main finding was that pediatricians at all levels are familiar with CPGs and use them. In addition, our doctors believe that CPGs lead to good quality of care, are practical, provide standardized patient care, will keep them up-to-date, decrease the rate of litigation, are evidence-based, do not restrict continuity of self-education, do not alter physician esteem, lead to improvement of outcome, and are practical. However, barriers that might impede pediatricians’ use of CPGs are that CPGs affect their clinical judgment, do not match with their practice style, and do not reduce health care costs.ConclusionsPediatricians at HMC have positive perceptions of CPGs. The results of our study suggest that CPGs are likely to be implemented if more counseling and education are provided to pediatricians regarding the usefulness of evidence-based guidelines. In addition, a program should be initialized to remove barriers while simultaneously addressing physicians’ concerns.

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Section: Discussioncontrasting

confidence: 64%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Pediatricians’ perceptions of clinical practice guidelines

Hendaus¹,

Alhammadi²,

Razig³

et al. 2014

JMDH

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“…In 2005, the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS), based upon data available to them, recommended empiric antibiotic treatment (ABX) guidelines for healthcare-acquired pneumonia (HCAP) including NHAP [11]. These treatment recommendations have not yet realized universal adherence, which may be due in part to the paucity of data available on NHAP [12,13]. …”

Section: Introductionmentioning

confidence: 99%

“…The management of NHAP continues to be controversial because of the scarcity of information on risk factors and diagnosis specific to this group of patients and lack of randomized controlled clinical trials that could help determine the best antimicrobial treatment regimen, length of treatment and rapid molecular techniques to ascertain etiological agents [15]. A previous study investigated the attitudes of physicians toward NHAP treatment guidelines and found that the core obstacles to implementation of the ATS/IDSA guidelines are apprehensions regarding the practicality of using the suggested regimens and absence of documented improved outcomes [13]. …”

Section: Introductionmentioning

confidence: 99%

Nursing home-acquired pneumonia: course and management in the emergency department

et al. 2014

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BackgroundPneumonia is among the foremost causes of hospitalization and mortality in patients residing in extended care facilities. Despite its prevalence, there is currently little literature focusing on the course and management of nursing home-acquired pneumonia (NHAP) in the emergency department (ED). Our objective was to investigate the ED presentation, course, management and outcomes in patients admitted through the ED with NHAP.MethodsA retrospective chart review of nursing home patients with a presumptive or final diagnosis of pneumonia admitted through the ED was performed at two large hospitals in Detroit, Michigan.ResultsA total of 296 patients were included in the study from 2002 to 2007 with a mean age of 81.1 years (SD ± 10.95) and 55.4% females. Blood cultures were performed on 90.8% of patients in the ED; 17.8% of these revealed growths, but half of these were considered contaminants. Initial chest x-ray in the ED was read as possible pneumonia in 18.2% of patients; 73.9% were started on antibiotics (ABX) in the ED. Mean hospital length of stay (LOS) was 10.75 days (SD ± 9.35) and in-hospital mortality was 16.2%. Time until first ABX in univariate analysis was nearly significant (p = 0.053) for mortality prediction, and the appropriate versus inappropriate ABX (per the Infectious Diseases Society of America and American Thoracic Society guidelines) did not affect mortality. Patients treated with a single ABX had significantly increased LOS (p = 0.0089). There was poor correlation between LOS and time until first ABX as well as LOS and time until appropriate ABX with a correlation coefficient of -0.048 (p = 0.42) and -0.08 (p = 0.43), respectively.ConclusionsIn this data set of NHAP patients admitted through the ED, we found a surprisingly low prevalence of true-positive blood cultures, high incidence of antibiotic pre-treatment at nursing homes prior to admission, high hospital mortality and low immunization rates. There was a wide spectrum of pathogens grown in blood culture. Only two thirds of the patients had dyspnea at presentation, and less than half had either cough or fever. On physical examination, about one fourth had no clinical findings consistent with pneumonia. Further, less than one fifth of chest x-rays were interpreted as possible pneumonia.

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