Factors and outcomes associated with physicians' adherence to recommendations of infectious disease consultations for inpatients.
Résumé
OBJECTIVES: Solicited consultations constitute a substantial workload for infectious disease specialists (IDSs). The impact of physician adherence to recommendations on clinical outcomes following solicited IDS consultations has not been previously studied. The objectives of the study were to identify the factors associated with adherence and to determine whether adherence to recommendations was associated with better clinical outcomes. METHODS: A prospective study was conducted on 621 patients, aged > or = 18 years, hospitalized in a university-affiliated hospital in France, who received an IDS consultation between December 2007 and June 2008. The main outcome was early clinical improvement, and the secondary outcomes were length of stay and in-hospital mortality. RESULTS: Adherence to the IDS's recommendations was 88.2% (548/621) for antimicrobial treatment and 72.2% (317/439) for diagnostic or monitoring tests. In a multivariable analysis, independent factors of adherence to therapeutic recommendations were a community-acquired infection [adjusted odds ratio (OR), 1.8; 95% confidence interval (CI), 1.1-3.0] and discontinuation or non-use of antibiotic treatment (adjusted OR, 9.7; 95% CI, 1.2-80.3). Adherence to recommendations for antibiotic treatment was associated with a higher rate of early clinical improvement (60.7% versus 43.9%, P = 0.01), shorter median length of stay (20 days versus 23 days, P = 0.03) and comparable in-hospital mortality (7.7% versus 5.5%, P = 0.50). CONCLUSIONS: Factors associated with non-adherence must be anticipated by IDSs during consultations, because non-adherence leads to worse clinical outcomes. Further studies are needed to identify the interventions that could improve physician adherence to recommendations made during solicited consultations.