Greining, meðferð og horfur lungnabólgu: niðurstöður frá þremur heilsugæslustöðvum

Abstract

Tilgangur: Að rannsaka hvernig heimilislæknar á höfuðborgarsvæðinu greina og meðhöndla samfélagslungnabólgu hjá fullorðnum og kanna útkomu. Efniviður og aðferðir: Afturskyggn sjúkraskrárskoðun yfir eitt ár hjá sjúklingum 18 ára og eldri sem greindir voru með samfélagslungnabólgu á þremur heilsugæslustöðvum á höfuðborgarsvæðinu. Niðurstöður: Alls voru 215 sjúklingar greindir með samfélagslungnabólgu. Af þeim voru 195 bæði greindir og meðhöndlaðir í heilsugæslu og 20 sjúklingum var vísað til eftirfylgni. Meðalaldur var 50,3 ár (SD=21,0) og 126 (65%) voru konur. Flestir sjúklingarnir höfðu verið veikir í minna en viku og voru ekki með greindan lungnasjúkdóm áður. Hósti var algengasta skráða einkennið (71%) og 96% voru með óeðlilega lungnahlustun. Lífsmörk voru sjaldan skráð. Röntgenmynd af lungum var gerð í þriðjungi tilfella og var óeðlileg í yfir 80% tilvika. Flestir sjúklingar (94%) voru meðhöndlaðir með sýklalyfjum og penicillinlyf með aukinni virkni var oftast notað. Símasamskipti voru algengasta form samskipta eftir greiningu og hjá 12% einstaklinga var sýklalyfjum breytt og hjá 10% var röntgenmynd gerð eftir greiningu. Enginn lést af völdum samfélagslungnabólgu á rannsóknartímabilinu. Ályktanir: Samfélagslungnabólga var greind klínískt og meðhöndluð í heilsugæslu í flestum tilvikum. Hún var algengari hjá konum og minnihluti sjúklinga hafði undirliggjandi lungnasjúkdóm. Lífsmörk voru mæld sjaldnar en búast mætti við. Breiðvirk sýklalyf voru mikið notuð. Enginn lést af völdum samfélagslungnabólgu.

To study how general practitioners diagnose and treat adult patients with community acquired pneumonia (CAP) and evaluate outcomes. Retrospective chart review for one year on patients 18 years and older diagnosed with CAP in three different primary care centers in Iceland. A total of 215 patients were diagnosed with CAP. Of those 195 were both diagnosed and treated in the primary health care and 20 patients were referred for specialized care. Mean age was 50.3 years (SD= 21.0) and 126 (65%) of the patients were women. Most patients had been ill for less than a week and did not have a previously diagnosed lung disease. Cough was the most common symptom (71%) and 96% had abnormal chest auscultation. Vital signs were frequently not recorded. A chest radiograph was done in third of the cases and showed abnormality in over 80%. Most patients (94%) were treated with antibiotics usually extended spectrum penicillin. Phone consultations were the most common form of communication after diagnosis and about 12% of subjects had their antibiotics changed and about 10% had a chest radiograph done after diagnosis had been made. There was no mortality from CAP during the study period. CAP was diagnosed clinically and managed in primary care in most cases. CAP was more common in women and a minority of patients had underlying lung diseases. Vital sign measurements were used less than expected. Broad spectrum antibiotics were widely used for treatment. CAP had no mortality.