Improvements Necessary in Treatment of Pneumonia

Tuesday, February 8th 2000, 12:00 am

By: News On 6

It was a busy flu season for doctors around the country. There was an increase in the number of pneumonia cases, a serious complication of influenza. Treating the illness is critical, but a new survey has found room for improvement in treatment and cost.

Pneumonia is a serious, sometimes deadly lung infection, often caused by bacteria. 48- year-old John Greer has a long history of heart disease and thought he was recovering from a bout with the flu. "I woke up early in the morning,â€ Greer recalled. â€œI was admitted to the hospital and sat in bed and felt extremely dizzy and laid back down again. I think I may have lost consciousness."

Greer needed to be in the hospital. But doctors say differences in where and how patients are treated reflects a lack of generally accepted guidelines. â€œThe admission rate for pneumonia can vary as much as three-fold from one hospital to the next,â€ said University of Aberta spokesperson Dr. Thomas Marrie. â€œThe types of antibiotics used also differ. So in summary, there is a great variation in the treatment of pneumonia, and we wanted to eliminate some of that variation.â€

A group of Canadian researchers instituted "pathway guidelines", for treating community-acquired pneumonia at nine hospitals. Ten other hospitals continued their conventional pneumonia treatment. Critical pathway guidelines included a system to rate the severity of pneumonia, greater use of oral antibiotics and giving only one antibiotic rather than several. The study is published in this week's issue of the Journal of the American Medical Association.

Researchers compared the hospitals using convential guidelines and those adopting the new pathway guidelines for treating pneumonia. Doctors say the new guidelines reduced the number of low risk hospital admissions by 18 per cent. Those admitted were able to leave the hospitals two days earlier. After six weeks, the rates of complications, re-admissions and death were similar in both hospital groups. "A critical pathway for the treatment of pneumonia allows for better care for patients and that more can be treated safely at home,â€ said Marrie. â€œSo the patients are satisfied, and there are major cost savings to the health care system.

Doctors say that savings amounted to about $1,700 per patient treated under the new pathway guidelines. Doctors stress this is not cookbook medicine. The critical pathway is just an aid to help physicians do a better job. The doctor's judgement ultimately overrides any part of the guidelines.