A clinical pathway along with monthly feedback may help to improve adherence to guideline-concordant care for patients with community-acquired pneumonia (CAP), according to a study published in Plos One.
CAP is a major cause of hospitalization and death around the world, with inpatient mortality rates cited to be as high as 23%. As such, a number of practice guidelines have been developed to help promote prompt and effective treatment for patients with CAP. Despite a demonstrated success at improving outcomes for patients, compliance with CAP guidelines remains poor.
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In a study led by Maher Almatar, PhD, University of Tasmania, Hobart (Australia), researchers compared the relative effectiveness of two interventions: an educational program focusing on the development of local CAP guidelines and their dissemination through hospital-wide programs; and a clinical pathway for initial management of patients with CAP, followed by monthly feedback to the emergency department physicians about concordance rates with the guidelines.
A total of 398 patients records were included and reviewed in the study. Prior to beginning either intervention, the adherence rate to CAP guidelines was 22.2%. However, through the use of a clinical pathway, researchers found that guideline adherence fluctuated between 40.9% at its lowest and 77.3% at its highest, with a mean of 61.5%. Concordance rates during the baseline and educational intervention periods were similar (28.1% vs 31.2%, respectively).
Researchers concluded that an emergency department intervention that includes a clinical pathway and monthly feedback may be a successful strategy for improving adherence to CAP guidelines. In contrast, educational interventions alone may only led to marginal improvements with respect to guideline adherence, making a clinical pathway the preferable approach.
However, researchers did also acknowledge some limitations associated with their study, most notably the fact that some aspects of the guideline recommendations, such as de-escalation of antibiotics during admission, supportive care, and duration of antibiotic treatment, were not measured in the study.
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Editor's Note: An updated version of this article has been provided that lists Maher Almatar, PhD, as the lead author of the study. The previous version of the article had listed Syed Tabish R Zaidi, BPharm, MPharm, as the lead author.
