Quality of investigation and treatment of community-acquired pneumonia - a comparative study between departments of internal medicine in NU-sjukvården and swedish departments of infectious diseases

Abstract

Master thesis, Programme in Medicine. TITLE: Quality of investigation and treatment of community-acquired pneumonia - a comparative study between departments of internal medicine in NU-sjukvården and swedish departments of infectious diseases. AUTHOR: Emma Asplund. Community-acquired pneumonia is a common disease which yearly affects 1 of 100 persons and it is the most common infection diagnosis in all in-patient hospital care. The swedish society of infectious diseases has set up a number of targets regarding the quality of pneumonia care in departments of infectious diseases. The targets means that CRB65-score (=a prognostic tool that takes into account the presence of confusion, the respiratory rate, blood pressure and age) should be calculated and noted for at least 50 % of patiens with suspected pneumonia, blood cultures and airway cultures should be taken from all these patients and at least 75 % of the patients should have PcV or PcG as initial treatment. The result of target accomplishment is documented in a national quality register (NQPR). The majority of patients who is treated for community-acquired pneumonia in inpatient hospital care is however treated in departments of internal medicine. Therefore, it is interesting to investigate the target accomplishment in these departments and compare the results with the results from departments of infectious diseases. The aim with this master thesis in medicine is to compare patients who have been treated for community-acquired pneumonia in departments of internal medicine with patientes who have been treated in departments of infectious diseases, with respect to antibiotic treatment, the use of CRB65- score for therapy choise and the use of cultures. 100 medical records from patients treated for community-acquired pneumonia in departments of internal medicine in NU-sjukvården during 2012 were examined and the results were compared with data from the national pneumonia register. The result shows that CRB65-score was not mentioned in any enrollment record, and enough information to calculate the CRB65-score was missing in 51 % of the records. Blood cultures were taken in 83 % (91.3 % in the NQPR) and airway cultures were taken in 21 % of the patients (76.3 % in the NQPR). 74 % received PcV or PcG as initial antibiotic, which is a higher number than in the NQPR. Conclusion: The target to treat at least 75 % with PcV or PcG was almost achieved in the departments of internal medicine, as 74 % got these antibiotics. The other targets were not achieved neither in departments of internal medicine, nor in departments of infectious diseases.