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American Journal of Medical Quality
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Getting Physicians to Make "The Switch": The Role of Clinical Guidelines in the Management of Community-Acquired Pneumonia

Jared T. Hagaman, MD

Department of Medicine at the University of Cincinnati College of Medicine

Peter Yurkowski, PharmD

Pharmacy Services, the University Hospital, Health Alliance of Greater Cincinnati, Ohio

Alexander Trott, MD

University of Cincinnati College of Medicine, Department of Emergency Medicine; University Hospital; Health Alliance, Cincinnati, Ohio

Gregory W. Rouan, MD

Department of Internal Medicine, University of Cincinnati College of Medicine, Ohio

The authors sought to assess physician awareness and usage of American Thoracic Society guidelines for early conversion from intravenous to oral antibiotics ("switch therapy") in those with community-acquired pneumonia (CAP). We then determined if adoption of a CAP guideline would improve either. Patients (N = 510) hospitalized with CAP from June 2002 to May 2003 were identified retrospectively, and chart reviews were done on a random sample (130 [25%]) of these. Physicians were surveyed before and after guideline adoption. Community-acquired pneumonia guideline implementation increased physician awareness of American Thoracic Society recommendations (5% to 40%) and use of switch therapy (60% to 86%). Such use resulted in decreased overall length of stay from 3.6 to 2.4 days (P < .05) and from 2.91 to 2.41 days (P < .05) among early-switch candidates. Early-switch therapy was not optimally used prior to implementation of this CAP guideline. Adoption of the guideline increased awareness and reduced length of stay among inpatients with CAP.

Key Words: guidelines • community-acquired pneumonia (CAP) • antibiotic therapy

American Journal of Medical Quality, Vol. 20, No. 1, 15-21 (2005)
DOI: 10.1177/1062860604273748
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This article has been cited by other articles:


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 Int J Qual Health CareHome page
P.-J. Cortoos, S. Simoens, W. Peetermans, L. Willems, and G. Laekeman
Implementing a hospital guideline on pneumonia: a semi-quantitative review
Int. J. Qual. Health Care, December 1, 2007; 19(6): 358 - 367.
[Abstract] [Full Text] [PDF]


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