Abstract
Up to 70% of patients report ongoing symptoms 4 weeks after hospitalisation for pneumonia; the impact on primary care is poorly understood. To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. A population-based cohort study in England using a UK primary care database of anonymised medical records (Clinical Practice Research Datalink [CPRD]) linked to Hospital Episode Statistics (HES). Adults with the first International Classification of Diseases, 10th Revision (ICD-10) code for pneumonia (J12-J18) recorded in HES between July 2002 and June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Of 56 396 adults, 55.9% (n = 31 542) consulted primary care within 30 days of hospital discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year before index admission (adjusted subhazard ratio [sHR] 8.98, 95% confidence interval [CI] = 6.42 to 12.55). The most common reason for consultation was for a respiratory disorder (40.7%, n = 12 840), 11.8% for pneumonia specifically. At consultation, 31.1% (n = 9823) received further antibiotics. Penicillins (41.6%, n = 5753/13 829) and macrolides (21.9%, n = 3029/13 829) were the most common antibiotics prescribed. Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.
Highlights
Community acquired pneumonia (CAP) accounts for 5%–12% of lower respiratory tract infections (LRTIs) presenting to primary care in the UK.[1,2] Little is known about the morbidity related to recovery from pneumonia
Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia
Over the 15-year study period, there were 215 828 patients admitted to hospital with ICD-10 codes for pneumonia (Figure 1), and after exclusions, the study cohort comprised 56 396 patients
Summary
Community acquired pneumonia (CAP) accounts for 5%–12% of lower respiratory tract infections (LRTIs) presenting to primary care in the UK.[1,2] Little is known about the morbidity related to recovery from pneumonia. A systematic literature review of patient reported outcomes in CAP found limited research suggesting that up to 70% of patients report at least one symptom 4-weeks post-discharge, the most common symptom being fatigue, followed by cough and dyspnoea.[3]. A meta-analysis estimated the pooled 30-day readmission rate to be 10%, with 31% of readmissions due to pneumonia-related reasons.[4] In the UK, 30-day readmission following CAP has increased from 10.5% in 2009/10 to 14.6% in 2018/19.5 In contrast, the impact on primary care is much less understood. Up to 70% of patients report ongoing symptoms 4 weeks after hospitalisation for pneumonia; the impact on primary care is poorly understood
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