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Adherence of Physicians to Local Guideline Recommendations among Patients with COVID-19 in Two Tertiary Public
Anton G Elepaño1, Cynthia P Cordero2, Lia M Palileo-Villanueva3
1Department of Medicine, Philippine General Hospital, University of the Philippines Manila.
Insights
Physician adherence to COVID-19 clinical guidelines was generally good, but tocilizumab was underused and antibiotics were overused in some cases. Rapid assessments can improve quality of care and resource use during health emergencies.
Area of Science:
- Health Services Research
- Infectious Disease Management
- Clinical Practice Guideline Implementation
Background:
- Clinical practice guidelines (CPG) are crucial for standardizing care and improving patient outcomes.
- Evaluating adherence to CPGs, especially during public health emergencies like COVID-19, is essential for quality improvement.
- This study assessed adherence to COVID-19 CPGs in two tertiary public hospitals.
Purpose of the Study:
- To evaluate physician adherence to local clinical practice guidelines for COVID-19 management.
- To identify areas of guideline adherence, overuse, and underuse.
- To analyze adherence variations based on disease severity and hospital unit.
Main Methods:
- A multicenter, retrospective chart review using a rapid assessment method.
- Assessed adherence to 15 strong recommendations from the Philippine COVID-19 Living Recommendations.
- Reviewed 723 patient charts admitted between July and October 2021.
Main Results:
- High adherence (91.4%) to dexamethasone for hypoxemia, with 9.2% overuse.
- Significant underuse of tocilizumab (52.2%) when indicated, potentially due to supply shortages.
- Widespread overuse of empiric antibiotics (43.6%) in patients without bacterial coinfection.
- Lowest adherence to antibiotic use was observed in critically ill patients and those in the ICU.
Conclusions:
- COVID-19 management in the studied hospitals generally aligned with guidelines.
- Key issues identified include tocilizumab underuse and antibiotic overuse.
- Recommends rapid assessment studies as a quality improvement tool for guideline adherence and resource management, particularly during public health crises.
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.
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