Assessing decision of inpatient or outpatient care in community acquired pneumonia: APT care study

Objective: To estimate the proportion of community-acquired pneumonia patients with disagreement between Confusion, Uraemia, Respiratory rate, Blood pressure, age >= 65 years recommendation and physician's decision to hospitalise or not. Methods: This cross-sectional nation-wide, non-interventional, cross-sectional study was carried out across 10 cities of Pakistan from December 2011 to May 2012, and recruited consenting adult patients with confirmatory diagnosis of community-acquired pneumonia on chest X-ray. Confusion, Uraemia, Respiratory rate, Blood pressure, age >= 65 years recommendation for each patient was determined at the time of analysis. This recommendation was compared with treatment decision made by the physician. Disagreement was considered when the physician's decision did not match with the recommendation. SPSS 18 was used for data analysis. Results: Of the 352 patients, 201(57.10%) were males. The overall mean age was 50.67+/-18.45 years. In 140(39.77%) patients there was disagreement between Confusion, Uraemia, Respiratory rate, Blood pressure, age >= 65 years recommendation and physician's decision regarding hospitalisation or outpatient care. Of the 352 cases 132(37.50%) were hospitalised despite the recommendation of outpatient treatment. Conclusion: In almost four out of every 10 patients there was disagreement between Confusion, Uraemia, Respiratory rate, Blood pressure, age >= 65 years recommendation and the physician's decision regarding hospitalisation of community-acquired pneumonia patients.