Abstract
The purpose of this study was to compare compliance with recommendations and clinical outcomes between formal and informal infectious disease specialist consultations. Six hundred twenty-seven consecutive adult inpatients who received an infectious disease consultation in a university-affiliated hospital were included. After adjusting for quintile of propensity score, we compared compliance with the consultant’s recommendations and clinical outcomes for 443 (70.7%) and 184 (29.3%) formal and informal consultations. Informal and formal consultations were associated with comparable levels of compliance with recommendations for antimicrobial treatment (86.5% vs 88.9%; adjusted odds ratio [aOR], 0.63; 95% confidence interval, 0.34–1.14; P = 0.13) and diagnostic or monitoring tests (72.6% vs 72.0%; aOR, 0.91 [0.53–1.57]; P = 0.73). The rates of early clinical improvement (58.2% vs 58.6%; aOR, 1.11 [0.70–1.74]; P = 0.66), subsequent consultation (34.2% vs 36.3%; aOR, 0.80 [0.53–1.21]; P = 0.29), in-hospital mortality (4.9% vs 8.4%; aOR, 0.55 [0.24–1.24]; P = 0.15), and the median length of stay (23 vs 20 days; aOR of discharge, 0.90 [0.74–1.10]; P = 0.30) did not differ depending on the type of consultation. This study provides observational evidence that informal consultations result in levels of compliance with recommendations comparable to formal consultations, without compromising patient safety. Further study is needed to refine the criteria for requesting or providing informal rather than formal consultations.
Similar content being viewed by others
References
Golub RM (1998) Curbside consultations and the viaduct effect. JAMA 280(10):929–930
Forrest CB (2009) A typology of specialists' clinical roles. Arch Intern Med 169(11):1062–1068
Gennai S, Francois P, Sellier E, Vittoz JP, Hincky-Vitrat V, Pavese P. (2010) Prospective study of telephone calls to a hotline for infectious disease consultation: analysis of 7,863 solicited consultations over a 1-year period. Eur J Clin Microbiol Infect Dis. [Epub ahead of print]
Kuo D, Gifford DR, Stein MD (1998) Curbside consultation practices and attitudes among primary care physicians and medical subspecialists. JAMA 280(10):905–909
Pearson SD, Moreno R, Trnka Y (1998) Informal consultations provided to general internists by the gastroenterology department of an HMO. J Gen Intern Med 13(7):435–438
Borowsky SJ (1998) What do we really need to know about consultation and referral? J Gen Intern Med 13(7):497–498
Keating NL, Zaslavsky AM, Ayanian JZ (1998) Physicians' experiences and beliefs regarding informal consultation. JAMA 280(10):900–904
Manian FA, Janssen DA (1996) Curbside consultations. A closer look at a common practice. JAMA 275(2):145–147
Fox BC, Siegel ML, Weinstein RA (1996) "Curbside" consultation and informal communication in medical practice: a medicolegal perspective. Clin Infect Dis 23(3):616–622
Duncan CJ, Gallacher K, Kennedy DH, Fox R, Seaton RA, MacConnachie AA (2007) Infectious disease telephone consultations: Numerous, varied and an important educational resource. J Infect 54(5):515–516
Leblebicioglu H, Akbulut A, Ulusoy S et al (2003) Informal consultations in infectious diseases and clinical microbiology practice. Clin Microbiol Infect 9(7):724–726
Schlesinger Y, Paltiel O, Yinnon AM (1998) Analysis and impact of infectious disease consultations in a general hospital. J Hosp Infect 40(1):39–46
Yinnon AM (2001) Whither infectious diseases consultations? Analysis of 14,005 consultations from a 5-year period. Clin Infect Dis 33(10):1661–1667
Ballard WP, Gold JP, Charlson ME (1986) Compliance with the recommendations of medical consultants. J Gen Intern Med 1(4):220–224
Sears CL, Charlson ME (1983) The effectiveness of a consultation. Compliance with initial recommendations. Am J Med 74(5):870–876
Sellier E, Pavese P, Gennai S, Stahl JP, Labarere J, Francois P (2010) Factors and outcomes associated with physicians' adherence to recommendations of infectious disease consultations for inpatients. J Antimicrob Chemother 65(1):156–162
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147(8):573–577
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383
Eron LJ, Passos S (2001) Early discharge of infected patients through appropriate antibiotic use. Arch Intern Med 161(1):61–65
Halm EA, Fine MJ, Marrie TJ et al (1998) Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA 279(18):1452–1457
D'Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17(19):2265–2281
Joffe MM, Rosenbaum PR (1999) Invited commentary: propensity scores. Am J Epidemiol 150(4):327–333
Myers JP (1984) Curbside consultation in infectious diseases: a prospective study. J Infect Dis 150(6):797–802
Lo E, Rezai K, Evans AT et al (2004) Why don't they listen? Adherence to recommendations of infectious disease consultations. Clin Infect Dis 38(9):1212–1218
Conley J, Jordan M, Ghali WA (2009) Audit of the consultation process on general internal medicine services. Qual Saf Health Care 18(1):59–62
Salerno SM, Hurst FP, Halvorson S, Mercado DL (2007) Principles of effective consultation: an update for the 21st-century consultant. Arch Intern Med 167(3):271–275
McPhee SJ, Lo B, Saika GY, Meltzer R (1984) How good is communication between primary care physicians and subspecialty consultants? Arch Intern Med 144(6):1265–1268
Fox BC (1996) Medical-legal aspects of curbside consultation. JAMA 276(20):1635–1636
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sellier, E., Labarère, J., Gennai, S. et al. Compliance with recommendations and clinical outcomes for formal and informal infectious disease specialist consultations. Eur J Clin Microbiol Infect Dis 30, 887–894 (2011). https://doi.org/10.1007/s10096-011-1172-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-011-1172-7