Consultation in university-based and community-based infectious disease practices: a prospective study

Area of Science:

• Infectious Diseases
• Epidemiology
• Healthcare Management

Background:

• Infectious disease consultations are crucial for inpatient care.
• Understanding the patterns of these consultations in different practice settings is essential for resource allocation and training.

Purpose of the Study:

• To compare the characteristics and scope of infectious disease consultations in university-based versus community practices.
• To identify common pathogens, affected organ systems, and disease processes leading to consultations.

Main Methods:

• A 7-month prospective study involving 1,366 inpatient consultations.
• Data collected by infectious disease physicians using a standard data form.
• Comparison of consultation rates, pathogen types, affected systems, and physician activities between university and community practices.

Main Results:

• Consultation rates were higher in university practices (3.4 vs. 1.8 per 100 discharges).
• Bacterial pathogens accounted for over half of consultations; pulmonary, skin/soft tissue, and musculoskeletal infections were most common.
• Common diagnoses included bloodstream infection, pneumonia, unexplained fever, osteomyelitis, UTI, and cellulitis.
• Noninfectious disease consultations and recommendations for antimicrobial therapy changes were similar in both settings.
• Community practice physicians conducted more weekend and after-hours consultations.

Conclusions:

• The scope and diversity of infectious disease consultations are comparable between university and community practices.
• Bacterial infections, particularly pulmonary and skin-related, are primary drivers for consultations.
• Differences exist in consultation timing, with community physicians handling more off-hours cases.