What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia?

E. A. Halm, G. E. Switzer, B. S. Mittman, M. B. Walsh, C. C H Chang, M. J. Fine

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

OBJECTIVE: One of the major factors influencing length of stay for patients with community-acquired pneumonia is the timing of conversion from intravenous to oral antibiotics. We measured physician attitudes and beliefs about the antibiotic switch decision and assessed physician characteristics associated with practice beliefs. DESIGN: Written survey assessing attitudes about the antibiotic conversion decision. SETTING: Seven teaching and non-teaching hospitals in Pittsburgh, Pa. PARTICIPANTS: Three hundred forty-five generalist and specialist attending physicians who manage pneumonia in 7 hospitals. MEASUREMENTS AND RESULTS: Factors rated as "very important" to the antibiotic conversion decision were: absence of suppurative infection 93%), ability to maintain oral intake 79%), respiratory rate at baseline 64%), no positive blood cultures 63%), normal temperature 62%), oxygenation at baseline 55%), and mental status at baseline 50%). The median thresholds at which physicians believed a typical patient could be converted to oral therapy were: temperature ≤100°F 37.8°C), respiratory rate ≤20 breaths/minute, heart rate ≤100 beats/minute, systolic blood pressure ≥100 mm Hg, and room air oxygen saturation ≥90%. Fifty-eight percent of physicians felt that "patients should be afebrile for 24 hours before conversion to oral antibiotics," and 19% said, "patients should receive a standard duration of intravenous antibiotics." In univariate analyses, pulmonary and infectious diseases physicians were the most predisposed towards early conversion to oral antibiotics, and other medical specialists were the least predisposed, with generalists being intermediate P < .019). In multivariate analyses, practice beliefs were associated with age, inpatient care activities, attitudes about guidelines, and agreeableness on a personality inventory scale. CONCLUSIONS: Physicians believed that patients could be switched to oral antibiotics once vital signs and mental status had stabilized and oral intake was possible. However, there was considerable variation in several antibiotic practice beliefs. Guidelines and pathways to streamline antibiotic therapy should include educational strategies to address some of these differences in attitudes.

Original languageEnglish (US)
Pages (from-to)599-605
Number of pages7
JournalJournal of General Internal Medicine
Volume16
Issue number9
DOIs
StatePublished - 2001

Fingerprint

Pneumonia
Anti-Bacterial Agents
Physicians
Respiratory Rate
Guidelines
Blood Pressure
Personality Inventory
Temperature
Aptitude
Vital Signs
Lung Diseases
Communicable Diseases
Inpatients
Length of Stay
Teaching
Multivariate Analysis
Heart Rate
Air
Oxygen
Therapeutics

Keywords

  • Antibiotic therapy
  • Physician attitudes
  • Pneumonia
  • Streamlining

ASJC Scopus subject areas

  • Internal Medicine

Cite this

What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia? / Halm, E. A.; Switzer, G. E.; Mittman, B. S.; Walsh, M. B.; Chang, C. C H; Fine, M. J.

In: Journal of General Internal Medicine, Vol. 16, No. 9, 2001, p. 599-605.

Research output: Contribution to journalArticle

Halm, E. A. ; Switzer, G. E. ; Mittman, B. S. ; Walsh, M. B. ; Chang, C. C H ; Fine, M. J. / What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia?. In: Journal of General Internal Medicine. 2001 ; Vol. 16, No. 9. pp. 599-605.
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AU - Chang, C. C H

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AB - OBJECTIVE: One of the major factors influencing length of stay for patients with community-acquired pneumonia is the timing of conversion from intravenous to oral antibiotics. We measured physician attitudes and beliefs about the antibiotic switch decision and assessed physician characteristics associated with practice beliefs. DESIGN: Written survey assessing attitudes about the antibiotic conversion decision. SETTING: Seven teaching and non-teaching hospitals in Pittsburgh, Pa. PARTICIPANTS: Three hundred forty-five generalist and specialist attending physicians who manage pneumonia in 7 hospitals. MEASUREMENTS AND RESULTS: Factors rated as "very important" to the antibiotic conversion decision were: absence of suppurative infection 93%), ability to maintain oral intake 79%), respiratory rate at baseline 64%), no positive blood cultures 63%), normal temperature 62%), oxygenation at baseline 55%), and mental status at baseline 50%). The median thresholds at which physicians believed a typical patient could be converted to oral therapy were: temperature ≤100°F 37.8°C), respiratory rate ≤20 breaths/minute, heart rate ≤100 beats/minute, systolic blood pressure ≥100 mm Hg, and room air oxygen saturation ≥90%. Fifty-eight percent of physicians felt that "patients should be afebrile for 24 hours before conversion to oral antibiotics," and 19% said, "patients should receive a standard duration of intravenous antibiotics." In univariate analyses, pulmonary and infectious diseases physicians were the most predisposed towards early conversion to oral antibiotics, and other medical specialists were the least predisposed, with generalists being intermediate P < .019). In multivariate analyses, practice beliefs were associated with age, inpatient care activities, attitudes about guidelines, and agreeableness on a personality inventory scale. CONCLUSIONS: Physicians believed that patients could be switched to oral antibiotics once vital signs and mental status had stabilized and oral intake was possible. However, there was considerable variation in several antibiotic practice beliefs. Guidelines and pathways to streamline antibiotic therapy should include educational strategies to address some of these differences in attitudes.

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