Potena A, Simoni M, Cellini M, Cartabellotta A, Ballerin L, Piattella M, Putinati S
Respiratory Physio-Pathology Unit, Azienda Ospedaliero-Universitaria, Ferrara, Italy.
Int J Tuberc Lung Dis. 2008 Jan;12(1):19-25.
Community-acquired pneumonia (CAP) is a respiratory health disease with a high prevalence in the general population. Family general practitioners (GPs) can play an important role in CAP management by reducing unnecessary hospital admissions and, consequently, national health costs.
To assess CAP management by trained GPs.
A course in CAP management, including a risk classification method based only on clinical criteria, was developed within the framework of an educational programme. GPs who participated in the programme (n = 220) were asked to collect data on their CAP patients.
GPs (n = 94, response rate 42.7%) provided information on 370 patients (50% males, aged 18-93 years). The numbers of patients judged to be at low, moderate and high risk were 81%, 13% and 6%, respectively. The admission rate was 19.5%. All home-treated patients had good clinical outcomes. Home treatment was based on quinolones (62%), beta-lactams (23%) and macrolides (15%). The attributable economic mean cost of antibiotic home treatment was euro 96 per episode (standard deviation 71, range 17-445).
The good outcomes suggest that GPs managed their CAP patients well, adhering to the content of the CAP management course. The risk evaluation of patients admitted to hospital, based exclusively on clinical elements, was consistent with more complex classification.
社区获得性肺炎（CAP）是一种在普通人群中患病率很高的呼吸道疾病。家庭全科医生（GP）通过减少不必要的住院次数，从而降低国家医疗成本，在CAP管理中可以发挥重要作用。
评估经过培训的全科医生对CAP的管理情况。
在一个教育项目框架内开发了一个CAP管理课程，包括一种仅基于临床标准的风险分类方法。要求参加该项目的全科医生（n = 220）收集其CAP患者的数据。
全科医生（n = 94，回复率42.7%）提供了370例患者（50%为男性，年龄18 - 93岁）的信息。被判定为低、中、高风险的患者人数分别为81%、13%和6%。住院率为19.5%。所有居家治疗的患者临床结局良好。居家治疗以喹诺酮类药物（62%）、β-内酰胺类药物（23%）和大环内酯类药物（15%）为基础。抗生素居家治疗的平均可归因经济成本为每次发作96欧元（标准差71，范围17 - 445）。
良好的结局表明全科医生对其CAP患者管理良好，遵循了CAP管理课程的内容。仅基于临床因素对住院患者进行的风险评估与更复杂的分类结果一致。
