Connect
MJA
MJA

Home management of mild to moderately severe community-acquired pneumonia: a randomised controlled trial

Dee A Richards, Les J Toop, Michael J Epton, G Ian Town, Robin D Dawson, Michael C Hlavac, Graham R B McGeoch, Simon M H Wynn-Thomas, Paul D Abernethy and Anja M Werno
Med J Aust 2005; 183 (5): 235-238.

Summary

Objective: To determine whether community management of mild to moderate community-acquired pneumonia (CAP) is as effective and acceptable as standard hospital management of CAP.

Design: Randomised controlled trial.

Setting: Christchurch, New Zealand, primary and secondary care.

Participants: 55 patients presenting or referred to the emergency department at Christchurch Hospital with mild to moderately severe pneumonia, assessed using a validated pneumonia severity assessment score, from July 2002 to October 2003.

Interventions: Hospital treatment as usual or comprehensive care in the home delivered by primary care teams.

Main outcome measures: Primary: days to discharge, days on intravenous (IV) antibiotics, patient-rated symptom scores. Secondary: health status measured using level of functioning at 2 and 6 weeks, patient satisfaction.

Results: The median number of days to discharge was higher in the home care group (4 days; range, 1–14) than in the hospital groups (2 days; range, 0–10; P = 0.004). There was no difference in the number of days on IV antibiotics or on subsequent oral antibiotics. Patient-rated symptom scores at 2 and 6 weeks, median change in symptom severity from baseline to 6 weeks, and general functioning at 2 and 6 weeks did not differ between the groups. Patients in both groups were satisfied with their treatment, with a clear preference for community treatment (P < 0.001).

Conclusions: Mild to moderately severe CAP can be managed effectively in the community by primary care teams. This model of comprehensive care at home can be implemented by primary care teams with suitable funding structures.

Please login with your free MJA account to view this article in full

  • Dee A Richards1
  • Les J Toop2
  • Michael J Epton3
  • G Ian Town4
  • Robin D Dawson5
  • Michael C Hlavac6
  • Graham R B McGeoch7
  • Simon M H Wynn-Thomas8
  • Paul D Abernethy9
  • Anja M Werno10

  • 1 Christchurch School of Medicine and Health Sciences, Otago University, Christchurch, NZ.
  • 2 Pegasus Health Independent Practitioners Association, Christchurch, NZ.
  • 3 Department of Microbiology, Canterbury Health Laboratories, Christchurch, NZ.

Correspondence: 

Acknowledgements: 

We thank the following for their help with the study: the Pegasus Health Extended Care team, especially Chris Tallott; members of the Christchurch CAP Research Team: Professor David Murdoch (Microbiology), Professor Stephen Chambers (Infectious Diseases), Dr Lance Jennings (Virology), Dr Richard Laing and Dr Martin Kelly (Respiratory Medicine), Dr Alan Pithie (General Medicine), Dr Martin Than and Dr Jan Bone (Emergency Medicine), Associate Professor Chris Frampton (biostatistician); the Emergency Department and General Medical teams; the staff of the Microbiology Department, especially Kirsten Beynon, Margaret Sutherland, Felicity Beats and Toni Stewart (Research Nurses) and Alison Parsons (Research Assistant).

Competing interests:

None identified.

  • 1. Neill A, Martin I, Weir R, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax 1996; 51: 1010-1016.
  • 2. Caplan GA, Ward JA, Brennan NJ, et al. Hospital in the home: a randomised controlled trial. Med J Aust 1999; 170: 156-160. <MJA full text>
  • 3. Grayson ML. Home intravenous antibiotic therapy. A safe and effective alternative to inpatient care. Med J Aust 1995; 162: 249-253.
  • 4. Montalto M. Patients’ and carers’ satisfaction with hospital-in-the-home care. Int J Qual Health Care 1996; 8: 243-251.
  • 5. Howden BP, Grayson ML. Hospital-in-the-home treatment of infectious diseases. Med J Aust 2002; 176: 440-445. <MJA full text>
  • 6. Carratala J, Fernandez-Sabe N, Ortega L, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med 2005; 142: 165-172.
  • 7. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-382.
  • 8. Jenkinson C, Layte R, Jenkinson D, et al. A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med 1997; 19: 179-186.
  • 9. Board N, Breenan NJ, Caplan GA. A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients. Aust N Z J Public Health 2000; 24: 305-311.
  • 10. Grayson ML. Hospital in the home development project. Development of Victorian disease-specific guidelines for hospital in the home (HITH). Final report. Melbourne: Monash Medical Centre, 1999.
  • 11. Metlay JP, Fine MJ, Schultz R, et al. Measuring symptomatic and functional recovery in patients with community-acquired pneumonia. J Gen Intern Med 1997; 12: 423-430.
  • 12. Folland S, Goodman AC, Stano M. Government regulation — principal regulatory mechanisms. In: The economics of health and health care. 3rd ed. New Jersey: Prentice Hall, 2001.
  • 13. Corwin P, Toop L, McGeoch G, et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ 2005; 330: 129-132.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.