EFFECTS OF INFECTIOUS DISEASE SPECIALIST CONSULTATION ON CLINICAL AND ECONOMIC OUTCOMES AMONG VENTILATOR-ASSOCIATED PNEUMONIA PATIENTS
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Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is a severe infection that occurs in hospitals, causing death in 45.00% of cases. The treatment for VAP varies among departments, with some doctors using antibiotics without consulting infectious disease specialists (ID), which can affect the outcome of the disease.
OBJECTIVE: To compare the effectiveness and cost of treatment for patients with VAP who receive care and consultation from ID specialists, versus those who do not.
METHODS: A retrospective cohort study was conducted on 713 patients with VAP over 15 years of age, between January 1st, 2015, and December 30th, 2019. Patients were divided into two groups: one group received care and consultation from ID specialists, while the other group was treated by doctors from other departments without ID consultation. The study analyzed the effectiveness and cost of treatment for both groups by reviewing electronic medical records. The results were analyzed using covariate adjustment using the propensity score method, multivariable risk regression, and linear regression. The level of statistical significance was determined using a p<0.05.
RESULTS: Out of 713 patients with VAP, 391 received care and consultation from ID specialists, while 322 did not. After matching the general information of patients with propensity score and analyzing with multivariable risk regression and linear regression, the study found that both groups had no significant difference in clinical improvement IRR = 0.93 (95% CI: 0.73-1.18, p=0.572). However, patients with ID consultation had a 4.71 times lower mortality rate than those without (95%CI: 0.36-0.63, p<0.001), and hospital stays for patients with ID consultation were 13.99 days shorter than those without (95%CI: 16.92-11.07, p<0.001). The study also found that medical costs were higher in patients with ID consultation, including direct medical cost, material cost, and total cost; direct medical cost was higher by 21,238.03 Baht (95%CI: 8,423.376-34,052.68, p=0.001), material cost was higher by 18,938 Baht (95%CI: 5,671.997-32,204, p=0.005), and total cost was higher by 40,176.02 Baht (95%CI: 115,964.87-64,387.17, p=0.001).
CONCLUSIONS AND RECOMMENDATIONS: ID consultation may increase medical costs, but it improves clinical outcomes and reduces mortality rates for patients with VAP. Thus, we recommend ID consultation in patients with VAP, particularly in cases where patients have pre-existing medical conditions and suffer from DRI, sepsis, and complications requiring more than two weeks of hospital stay and expensive antibiotics for severe cases.
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