A comparison of pneumonia care quality between general physicians and pulmonologists

Abstract

Background: We compared the quality of care for nursing- and healthcare-associated pneumonia (NHCAP) and aspiration pneumonia provided by general physicians and pulmonologists. Methods: Questionnaires were mailed to 2490 medical facilities across Japan. The questionnaire assessed participants’ implementation of microbiological investigations for NHCAP or aspiration pneumonia, as well as steps taken to prevent pneumonia recurrence (eg, use or discontinuation of drugs associated with swallowing and administration of pneumococcal polysaccharides). Survey results were statistically compared between the two groups using chi-square tests. Results: We received responses from 350 hospitals; of those, medical care for aspiration pneumonia was provided by pulmonologists at 190 hospitals and by general physicians at 79 hospitals. No significant differences were observed between the two groups of physicians for any of the items regarding proactive microbiological investigations or measures for preventing pneumonia recurrence. However, general physicians tended to be more proactive in conducting Gram's stains for sputum, sputum culture inspections, and blood culture tests. They also were more likely to implement measures for preventing pneumonia recurrence such as striving to increase patients’ consciousness levels, reducing medication doses, and discontinuing drugs that cause difficulty with swallowing (response rates of “is done in nearly all cases” were 73.4%, 88.6%, 36.7%, 35.4%, and 40.5%, respectively). Conclusions: The quality of care provided by general physicians may be on par with pulmonologists in terms of proactive microbiological investigations and preventing pneumonia recurrence.