Keywords
Guideline Adherence
Quality of Heath Care
How to Cite
Abstract
Introdution: community-acquired pneumonia is an acute infection of lung parenchyma, being nowadays an important cause of morbidity and mortality in Colombia. In this entity, poor health care quality and poor adherence to management guidelines has been associated with a negative impact on both, the clinical outcome of the patient and the academic and financial solvency of a university hospital. Objective: to describe the quality of medical care and adherence to the Colombian community-acquired pneumonia guideline in the Hospital Universitario de Santander during the 2014-2015 period. Methods: descriptive cross-sectional study. 121 clinical records with diagnosis of community-acquired pneumonia in the Hospital Universitario de Santander were selected. Variables regarding diagnostic approach, treatment assignment and general recommendations were collected from these, evaluating for each item the proportion of adherence to the guideline as well as the quality criteria in medical care defined by the Community Acquired Pneumonia Organization. Results: items
with best reported adherence were: complete blood count (100%) and chest X-ray (98%). On the other hand, CURB-65 classification (15%), chest X-ray indicated for the ambulatory control (12%), as well as recommendations for cessation of smoking and vaccination (0%), were the parameters with the lowest performance. Conclusions: there was evidence of failure in the clinical classification of the patient, which was associated with poor use of microbiological diagnostic laboratories and overuse of imaging studies such as computed tomography,
thus favoring inefficient treatment and development of bacterial pharmacological resistance. MÉD.UIS.2019;32(2):23-30
References
2. Marrie TJ, Huang JQ. Epidemiology of community-acquired pneumonia in Edmonton, Alberta: an emergency departmentbased study. Can Respir J. 2005 Apr;12(3):139–42.
3. Ramirez JA, Wiemken TL, Peyrani P, Arnold FW, Kelley R, Mattingly WA, et al. Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clin Infect
Dis Off Publ Infect Dis Soc Am. 2017 Nov 13;65(11):1806–12.
4. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice
Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis Off Publ Infect Dis Soc Am. 2016 Sep 1;63(5):e61–111.
5. Recomendaciones para el diagnóstico, tratamiento y prevención de la neumonía adquirida en la comunidad en adultos inmunocompetentes. Infectio. 2013 Mar 1;17:1–38.
6. Carvajal Estupiñán JF, Naranjo Junoy F, Ospina Diaz JM. Caracterización de pacientes diagnosticados con sepsis en una unidad de cuidados intensivos de Bucaramanga, Colombia 2010-2011: estudio descriptivo. Arch Med Manizales. 2016 Jun 30;16(1):53–60.
7. Jaramillo-Jaramillo L, Martínez-Sánchez L, Gaviria-García J. Neumonía adquirida en comunidad: Adherencia a las guías terapéuticas, importante eslabón en el desenlace clínico del paciente. Rev Cient Cienc Med 2015; 18(1): 36-42.
8. Metersky ML, Abend SL, Meehan TP. What have we learned about how to measure quality of care for patients with community-acquired pneumonia? Respir Care Clin N Am. 2005 Mar;11(1):87–98.
9. Ramírez J. An International, Observational Study to Evaluate Current Management of Hospitalized Patients with CommunityAcquired Pneumonia (International CAP Study) Protocol # 10,000 June
9, 2001 (Protocolo de investigación).
10. Christensen D, Luna C, Martinez J, Rodriguez E, Marzoratti L, Gonzalez J, et al. Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad:
esultados del estudio capo en Argentina. MEDICINA (Buenos Aires). 2007; 67: 709-713.
11. Machado-Alba JE, Isaza-Martínez B, Sepulveda-Marín M, Rivera-Palacios A, Ceballos SL. Nivel de adherencia a la guía de atención de neumonía adquirida en la comunidad en el Hospital Universitario San Jorge de Pereira, Colombia. Revista médica Risaralda. 2012;18(2):134-139.
12. Martínez C, Jaimes F, Montúfar F, Hincapié G, Morales A, Acero R, et al. Procesos de atención y prescripción en neumonía adquirida en la comunidad en hospitales universitarios en Colombia.
ev Colomb Neum.2003; 15(4):181-189.
13. Levy G, Perez M, Rodríguez B, Hernández Voth A, Perez J, Gnoni M, et al. Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad: resultados del Estudio Capo en Venezuela. Arch Bronconeumol. 2015 Apr 1;51(4):163–8.
14. Al-Abri SS, Al-Maashani S, Memish ZA, Beeching NJ. An audit of inpatient management of community-acquired pneumonia in Oman: a comparison with regional clinical guidelines. J Infect Public Health. 2012;5(3):250-6.
15. Conterno LO, Moraes FY, Silva Filho CR. Implementation of community-acquired pneumonia guidelines at a public hospital in Brazil. J Bras Pneumol. 2011;37(2):152-9.
16. Guo Q, Li HY, Zhou YP, Li M, Chen XK, Liu H, et al. Compliance with the CURB-65 score and the consequences of nonimplementation. Int J Tuberc Lung Dis. 2011;15(12):1697-702.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2019 Médicas UIS