A prospective cohort study of healthcare visits and rehospitalizations after discharge of patients with community-acquired pneumonia

Background and objective: The aim of this study was to identify the frequency of, reasons for, and risk factors associated with additional health-care visits and re-hospitalizations (health-care interactions) among patients with community-acquired pneumonia (CAP), within 30 days of discharge from hospital. Methods: This was an observational analysis of a prospective cohort of adults hospitalized with CAP at a tertiary hospital in 2007-2009. Additional health-care interactions were defined as visits to a primary care centre or emergency department, and hospital read-missions within 30 days of discharge. Results: Of the 934 patients hospitalized with CAP, 282 (34.1%) had additional health-care interactions within 30 days of discharge from hospital; 149 (52.8%) required an additional visit to a primary care centre and 177 (62.8%) attended the emergency department. Seventy-two patients (25.5%) were readmitted to hospital. The main reasons for additional health-care interactions were worsening of signs or symptoms of CAP and new or worsening comorbidities that were unrelated to pneumonia, mainly cardiovascular and pulmonary diseases. The only independent factor associated with visits to a primary care centre or the emergency department was alcohol abuse (OR 1.65; 95% CI: 1.03-2.64). Hospitalization in the previous 90 days (OR 2.47; 95% CI: 1.11-5.52) and comorbidities (OR 3.99; 95% CI: 1.12-14.23) were independently associated with re-hospitalization. Conclusions: Additional health-care visits and re-hospitalizations within 30 days of discharge from hospital were common among patients with CAP. This was mainly due to worsening of signs or symptoms of CAP and/or comorbidities. These findings may have implications for discharge planning and follow up of patients with CAP.