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Master Thesis

Caractéristiques et résultats cliniques associés à l'observance des avis formulés par une consultation mobile d'infectiologie pour les patients hospitalisés

Abstract : Background: Solicited consultations constitute a substantial workload for infectious diseases specialists (IDS). The impact of adherence of clinical outcomes for solicited IDS consultations has not been previously studies. The objectives of the study were to identify the factors associated with adherence and to determine whether adherence to recommendations was associated with better clinical outcomes. Methods: A prospective study was conducted in 621 patients, aged 18 years or older, hospitalized in a universityaffiliated hospital in France, who received an IDS consultation between December 2007 and June 2008. The main outcome was early clinical improvement and secondary outcomes were length of stay and inhospital mortality. Results: Adherence to IDS recommendation was 88.2% (548/621) for antimicrobial treatment and 72.2% (317/439) for diagnostic or monitoring test. In multivariable analysis, independent factors of adherence with therapeutic recommendations were a community-acquired infection (adjusted odds ratio 1.8, 95% confidence interval 1.1-3.0) and discontinuation or non-use of antibiotic treatment (9.7, 1.2-80.3). Adherence to recommendations for antibiotic treatment was associated with higher rate of early clinical improvement (60.7% v 43.9%, P = 0.01), shorter median length of stay (20 d v 23 d, P = 0.03), and comparable inhospital mortality (7.7% v 5.6%, P = 0.51). These associations were not altered after adjusting for age, hospital-acquired infection status, route of consultation, type of recommendation and requesting physician. Conclusions: Factors associated with non-adherence must be anticipated by IDS during the consultations as non-adherence lead to worse clinical outcomes. Further studies are needed to identify interventions that could improve adherence to IDS recommendations made during solicited consultations.
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Master Thesis
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Submitted on : Friday, July 26, 2013 - 9:51:07 AM
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  • HAL Id : dumas-00848358, version 1

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Elodie Sellier. Caractéristiques et résultats cliniques associés à l'observance des avis formulés par une consultation mobile d'infectiologie pour les patients hospitalisés. Médecine humaine et pathologie. 2009. ⟨dumas-00848358⟩

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