Management Of Community-Acquired Pneumonia: An Observational Study In UK Primary Care

Naomi Launders,1 Dermot Ryan,2 Christopher C Winchester,3 Derek Skinner,4 Priyanka Raju Konduru,4 David B Price4 1Respiratory Effectiveness Group, Cambridge, UK; 2Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Edinburgh EH8 9AG, Scotland; 3Oxford PharmaGenesis, Oxford, UK; 4Observational and Pragmatic Research Institute Pte Ltd, Singapore, SingaporeCorrespondence: David B PriceObservational and Pragmatic Research Institute Pte Ltd (OPRI), 60 Paya Lebar Road, Paya Lebar Square, Level 5, Unit 33 and 34, Singapore 409051, SingaporeTel +65 68029724Email dprice@opri.sgPurpose: In primary care, initial diagnosis of community-acquired pneumonia (CAP) is made on clinical judgment without radiological confirmation or knowledge of the causative organism. Use of CRB65 score has been recommended for assessing the severity of CAP and thereby determining clinical management, but it is not known how frequently these scores are used in primary care.Patients and methods: Primary care consultations in adults with a diagnostic code for CAP between 1 January 2009 and 31 December 2016 were extracted from the Optimum Patient Care Research Database, which at the time of data extraction had over 3.4 million patients in the UK. Episodes without antibiotic prescription on day of diagnosis were excluded, as were records describing past events. Patients admitted to hospital on day of diagnosis were excluded, but were included in exploratory analysis of CRB65 recording.Results: In total, 4734 episodes of CAP in adults managed in primary care between 1 January 2009 and 31 December 2016 were included. A range of investigations/observations were recorded, including pulse rate (10.7%), chest examinations (9.1%) and blood tests (5.4%). CRB65 scores were recorded in 19 (0.4%) episodes of CAP, 17 of which were after the publication of the NICE guidelines in December 2014. CRB65 recording was no more freque