Management Of Community-Acquired Pneumonia: An Observational Study In UK Primary Care
Received 4 April 2019
Accepted for publication 23 August 2019
Published 23 September 2019 Volume 2019:10 Pages 53—65
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Christoph R. Meier
Naomi Launders,1 Dermot Ryan,2 Christopher C Winchester,3 Derek Skinner,4 Priyanka Raju Konduru,4 David B Price4
1Respiratory Effectiveness Group, Cambridge, UK; 2Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh EH8 9AG, Scotland; 3Oxford PharmaGenesis, Oxford, UK; 4Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore
Correspondence: David B Price
Observational and Pragmatic Research Institute Pte Ltd (OPRI), 60 Paya Lebar Road, Paya Lebar Square, Level 5, Unit 33 and 34, Singapore 409051, Singapore
Tel +65 68029724
Purpose: In primary care, initial diagnosis of community-acquired pneumonia (CAP) is made on clinical judgment without radiological confirmation or knowledge of the causative organism. Use of CRB65 score has been recommended for assessing the severity of CAP and thereby determining clinical management, but it is not known how frequently these scores are used in primary care.
Patients and methods: Primary care consultations in adults with a diagnostic code for CAP between 1 January 2009 and 31 December 2016 were extracted from the Optimum Patient Care Research Database, which at the time of data extraction had over 3.4 million patients in the UK. Episodes without antibiotic prescription on day of diagnosis were excluded, as were records describing past events. Patients admitted to hospital on day of diagnosis were excluded, but were included in exploratory analysis of CRB65 recording.
Results: In total, 4734 episodes of CAP in adults managed in primary care between 1 January 2009 and 31 December 2016 were included. A range of investigations/observations were recorded, including pulse rate (10.7%), chest examinations (9.1%) and blood tests (5.4%). CRB65 scores were recorded in 19 (0.4%) episodes of CAP, 17 of which were after the publication of the NICE guidelines in December 2014. CRB65 recording was no more frequent in 3819 episodes referred to hospital (12, 0.3%; p=0.63), but where recorded, CRB65 scores were higher (Median: 1.0 [interquartile range: 0.5–1.0] vs 2.0 [interquartile range: 1.0–2.0], p=0.04). The most commonly prescribed antibiotic was amoxicillin (40.3%), and 85.9% of episodes had a prescription length of seven days.
Conclusion: CRB65 scores are seldom recorded in UK primary care. Given that these scores are embedded in UK guidelines, further work is required to assess feasibility and barriers to use of CRB65 scores in primary care.
Keywords: lower-respiratory tract infection, antibiotics, antimicrobials, guidelines adherence, CRB65
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