Why Don't They Listen? Adherence to Recommendations of Infectious Disease Consultations

Abstract

The effectiveness of an infectious diseases (ID) consultation is dependent on adherence to the recommendations. To delineate the factors that affect adherence, we conducted a prospective cohort study of 465 consultations at 2 academic institutions in which we evaluated the consultation process, patient and consultant characteristics, types of recommendations, and compliance with recommendations. The overall compliance rate was 80%, with 85% adherence to crucial recommendations. Multivariate analysis revealed that adherence to ID recommendations was higher when the recommendations were therapeutic instead of diagnostic, when they related to a specific clinical question, when recommendations were deemed crucial by the ID service, if the primary service was medicine, and if the consultation note was legible and organized. Whether modification of consultant practice will lead to improved recommendation compliance and patient outcomes warrants further study.

A Systematic Review and Meta-Analyses Show that Carbapenem Use and Medical Devices Are the Leading Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa

“…In addition, it is highly recommended that an infectious disease consultant with a broad view on the prevalence of MDR bacteria and knowledge of the most recent guidelines for antibiotic use in the hospital concerned be consulted. Indeed, studies have shown that consultation with an infectious disease consultant significantly increases the correct administration of microbiologically correct antibiotic therapy (30)(31)(32).…”

Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients

“…There is uncertainty about factors affecting adherence to recommendations [10]. In the present study, adherence (complete plus partial) was 59.5% or even lower if we consider only patients with complete adherence (34.9%).…”

“…In the present study, adherence (complete plus partial) was 59.5% or even lower if we consider only patients with complete adherence (34.9%). Although the percentage of complete + partial adherence is within the frame of 53% to 90% reported in the literature [10,23], complete adherence was lower. This low adherence in our study is worrying and can be related to the fact that eligible patients were identified when they were receiving antibiotic treatment for 3 days, a fact favoring not to follow recommendations in those patients with early favorable responses.…”

“…Most ID specialists believe that it is evident that their care is valuable, although there are few published studies on how frequently their recommendations are followed, or clinical consequences of following them [10,21]. Antimicrobial stewardship advocates the use of the most suitable antibiotic in the context of the presenting clinical condition and specific patient, and its success rely on coordination and collaboration between healthcare professionals to ensure consistency in approach, shared knowledge and widespread diffusion of practice [4].…”

“…IDs can improve effectiveness by recommending a more appropriate antibiotic use [7], and their positive impact on patient care and infection control has been demonstrated [8,9]. The effectiveness of infectious disease consultations depends not only on clinically astute recommendations, but also on the adherence to them, since without it even the best recommendations are rendered ineffective [10]. Consultation to IDs, although not always performed by treating physicians, is part of hospital’s daily practice.…”