Abstract
BackgroundRespiratory infections, like pneumonia, represent an important threat to the health of older Canadians. Our objective was to determine, at a community level, family and emergency room physicians' knowledge and beliefs about community acquired pneumonia (CAP) in older adults and to describe their self-reported assessment, management and prevention strategies.MethodsAll active ER and family physicians in Brant County received a mailed questionnaire. An advance notification letter and three follow-up mailings were used to maximize physician participation rate. The questionnaire collected information about physicians' assessment, management, and prevention strategies for CAP in older adults (≥60 years of age) plus demographic, training, and practice characteristics. The analysis highlights differences in approaches between office-based and emergency department physicians.ResultsSeventy-seven percent of physicians completed and returned the survey. Although only 16% of physicians were very confident in assessing CAP in older adults, more than half reported CAP to be a very important health concern in their practices. In-service training for family physicians was associated with increased confidence in CAP assessment and more frequent use of diagnostic tests. Family physicians who reported always requesting chest x-rays were also more likely to request pulse oximetry (OR 5.6, 95% CI 1.40 to 22.5) and recommend both follow-up x-rays (OR 5.4, 95% CI 1.7 to 16.6) and pneumococcal vaccination (OR 3.4, 95% CI 1.1 to 10.0).ConclusionThe findings of this study provide a snapshot of how non-specialists from a non-urban Ontario community assess, manage and prevent CAP in older adults and highlight differences between office-based and emergency department physicians. This information can guide researchers and clinicians in their efforts to improve the management and prevention of CAP in older adults.
Highlights
Respiratory infections, like pneumonia, represent an important threat to the health of older Canadians
We report the findings from a community-wide survey of family and emergency room (ER) physicians from one Ontario community to assess knowledge and beliefs about community acquired pneumonia (CAP) and ascertain variation in management strategies
Fifty-nine (79%) of the physicians reported their method of reimbursement as fee for service; 11 (15%) as salary; 3 (4%) as capitation and 2 (3%) as sessional payment
Summary
Respiratory infections, like pneumonia, represent an important threat to the health of older Canadians. Our objective was to determine, at a community level, family and emergency room physicians' knowledge and beliefs about community acquired pneumonia (CAP) in older adults and to describe their self-reported assessment, management and prevention strategies. Community-acquired pneumonia (CAP) is an important threat to older adults. Few studies have examined provision of care for CAP in entire communities. A vaccination trial set in a township in Finland allowed researchers the opportunity to assess etiology, incidence, and risk factors for CAP [4,5,6]. We report the findings from a community-wide survey of family and emergency room (ER) physicians from one Ontario community to assess knowledge and beliefs about CAP and ascertain variation in management strategies
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