Adherence of physicians to local guideline recommendations among patients with COVID-19 in two Tertiary Public Hospitals in Metro Manila, Philippines: A rapid assessment study
https://doi.org/10.47895/amp.vi0.6256
- Author:
Anton G. Elepaño
1
;
Cynthia P. Cordero
2
;
Lia M. Palileo-Villanueva
3
;
Nina T. Castillo-Carandang
2
;
Maria Teresa B. Abola
1
,
4
;
Jan Bendric C. Borbe
1
;
Vincent Anthony S. Tang
1
;
Jerahmeel Aleson L. Mapili
1
;
Bryan F. Elvambuena
1
;
Rogelio N. Velasco Jr
4
;
Leahdette O. Padua
4
;
Carl Lawrence C. Arenos
1
;
Leonila F. Dans
2
,
5
;
Antonio Miguel L. Dans
1
Author Information
1. Department of Medicine, Philippine General Hospital, University of the Philippines Manila
2. Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila
3. Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila
4. Clinical Research Department, Philippine Heart Center
5. Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
- Publication Type:Journal Article
- Keywords:
Rapid assessment
- MeSH:
Guideline Adherence;
COVID-19;
Quality Improvement
- From:
Acta Medica Philippina
2023;57(11):34-40
- CountryPhilippines
- Language:English
-
Abstract:
Objectives:Adherence to clinical practice guidelines (CPG) has been shown to reduce inter-physician practice
variation and improve quality of care. This study evaluated guideline adherence of physicians in two tertiary public hospitals to local CPG on COVID-19.
Methods:This was a multicenter, retrospective chart review, rapid assessment method study. Guideline adherence and non-adherence (overuse and underuse) to 15 strong recommendations in the prevailing Philippine COVID-19 Living Recommendations were assessed among a sample of patients admitted in two centers from July to October 2021. Differences in adherence across COVID-19 disease severities and managing hospital units were analyzed.
Results:A total of 723 patient charts from two centers were reviewed. Guideline adherence to dexamethasone use among patients with hypoxemia is 91.4% (95% CI 88.6 to 93.6) with 9.2% overuse. Tocilizumab was underused in 52.2% of patients with indications to receive the drug. There was overuse of empiric antibiotics in 43.6% of patients without suspicion of bacterial coinfection. Lowest adherence to antibiotic use was seen among patients with critical disease severity and those managed in the intensive care unit. None of the other non-recommended treatment modalities were given.
Conclusion:Management of COVID-19 in both centers was generally adherent to guideline recommendations.
We detected high underuse of tocilizumab probably related to the global supply shortage during the study
period and high overuse of antibiotics in patients without suspicion of bacterial coinfection. While the results of this study cannot be generalized in other healthcare settings, we recommend the application of similar rapid assessment studies in guideline adherence evaluation as a quality improvement tool and to identify issues with resource utilization especially during public health emergencies.
- Full text:6256-Other-133732-1-10-20231122.pdf
