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October - December 2011: 
Volume 24, Issue 4

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Pneumon 2011, 24(4):361-367
The adherence of Greek chest physicians to CAP Guidelines: The role of patient-related factors
Abstract
SUMMARY. Objective: Multiple international studies have shown that the adherence of chest physicians to guidelines is variable. In Greece there is lack of information on this subject. An epidemiological study was conducted to evaluate the temporal trends of the adherence to guidelines of Greek chest physicians. Retrospective assessment was made of their degree of adherence to international guidelines for the management of patients hospitalized for community acquired pneumonia (CAP) and the patient-related factors that influence this. Methods: The medical records were studied of 80 randomly selected patients admitted to the Chest Diseases Hospital of Athens in the first 6 months of 2000 with a presumptive diagnosis of CAP. Epidemiological and clinical data and information on admission criteria, diagnostic procedures and antibiotic treatment were collected from those fulfilling the diagnostic criteria for CAP. The appropriateness of the recorded procedures and treatment was evaluated in comparison to the CAP guidelines that were in use during the study period. Odds ratios (OR) for associated factors were calculated (the lower the OR value the lower the degree of adherence). Results: During the study period 67 eligible patients, with a mean age of 58.8 years, were identified. The rate of diagnostic procedures ranged from 100% for chest X-ray to 12% for blood culture. About 71% of patients had received appropriate antibiotic treatment on admission. An age of above than 70 years, altered mental status, aspiration, respiratory failure and multilobar pneumonia were found to be significant predictors of inappropriate therapy with ORs of 0.2 (95% CI: 0.1- 0.6, p=0.004), 0.04 (95% CI: 0-0.4, p=0.004), 0.04 (95% CI: 0-0.3, p=0.002), 0.3 (95% CI: 0-0.87, p=0.02), and 0.1 (95% CI:0.04-0.50, p=0.001) respectively. Aspiration was the most important factor for non-adherence on multivariate analysis adjusted for age (OR:0.05, 95% CI: 0.005-0.45, p=0.008). Conclusions: The adherence to CAP management guidelines was not grossly unsatisfactory but room for improvement was revealed. Pneumon 2011, 24(4):361-367.