La pneumònia adquirida a la comunitat (PAC) segueix essent una causa important d'hospitalització i mortalitat. Encara que més del 50% dels casos es tracten ambulatòriament, existeixen pocs estudis en els que s'incloguin aquests casos. Encara menys són els estudis que avaluen el consum de recursos a nivell de l'atenció primària. Es realitza el present estudi a la comarca d'El Maresme (Barcelona, Catalunya) amb la finalitat de conèixer el consum de recursos per la PAC, saber-ne el cost i elaborar una proposta de reducció de costos. Durant dos anys, i des d'una perspectiva poblacional, es recolliren tots els casos sospitosos de PAC amb confirmació radiològica, essent 224 d'ells inclosos en l'estudi, amb un 19% d'errors diagnòstics. La incidència obtinguda va ser de 1,51 casos per 1000 habitants i any, amb una taxa d'hospitalització del 59,8%. Es realitzaren una mitjana de 4,5 visites per pacient, de les quals la majoria a l'atenció primària. El diagnòstic s'efectuà majoritàriament al servei d'urgències hospitalàries. Encara que la millora clínica es va produir als 3-5 dies, l'estada hospitalària mitjana fou de 10 dies y la mitjana de dies de treball perduts va ser de 20. El cost del a PAC ingressada fou de 1.553 , dels quals el 84% fou degut a l'estada hospitalària. El tractament ambulatori de la PAC fou de 196 , representant el cost de les visites a l'atenció primària el 46%, les visites hospitalàries el 32% i el tractament antibiòtic el 20%.El 15,7% dels ingressos foren considerats inadequats i 242 dies d'estada hospitalària es consideraren també innecessaris, amb el qual el cost de la APC es podria reduir en un 17%.La PAC en aquesta zona presenta una incidència baixa, però un elevat grau d'hospitalització que condiciona un cost considerable, part del qual es podria reduir amb una millor coordinació entre els diversos nivells assistencials i l'aplicació de guies de pràctica clínica. / Community acquired pneumonia (CAP) remains a major cause of hospitalization and death. Although more than 50% of cases are treated as outpatients, these are rarely included in studies. Few studies evaluate the resource consumption at primary care. This study was performed in the El Maresme County (Barcelona, Catalonia) to assess the resource consumption for CAP, calculating its cost and elaborating a cost-reduction proposal. In this population-based study, conducted during two years, all suspected cases of CAP with radiological confirmation were included, obtaining 224 cases, with a 19% of misdiagnoses. The annual incidence obtained was 1,5 cases per 1000 inhabitants, and the hospitalization rate was 59,8%. A mean of 4,5 visits per patient were performed; being 72% of them primary care visits. Most cases were diagnosed at the hospital emergency departments. Although the clinical healing occurs between 3 and5 days, the mean length of hospital stay was 10 days and the mean days of work lost was 20 days.Hospitalized CAP cost 1.553 ; the 84% of this cost was due to hospital stay. The outpatient treatment of CAP cost 196 , representing the cost of primary care visits the 46% of this cost, hospital visits 32% and antibiotic treatment 20%.15,7% of hospitalizations were considered inadequate, and 242 hospitalization days were also considered unnecessary, so the cost of CAP could be reduced in 17%.CAP in this area presents a low incidence with high hospitalization rates that lead to considerable costs, which could partially be reduced by establishing a better coordination between different assistance levels and applying practice guidelines.

Treatment failure in community-acquired pneumonia (CAP) is the failure to normalize the clinical features (eg, fever, cough, sputum production), or nonresolving image in chest radiograph, despite antimicrobial therapy. The incidence of treatment failure in CAP has not been clearly established; according to several studies it ranges between 6% and 15%. The rate of mortality increases significantly, especially in those patients with severe CAP. It is important to be able to identify what patients are at risk for progressive or treatment failure pneumonia that may make them candidates for a more careful monitoring. This doctoral thesis has been structured following the guidelines of the rules for submission of doctoral theses as a compendium of publications, adopted by the Council, Department of Medicine, University of Barcelona. The studies are part of this thesis belong to the same line of research, validated the current guidelines of pneumonia-community acquired and hospital acquired. The results of the studies have provided relevant and innovative in this field and were collected in 2 original articles published in international journals with a widespread global impact factor of 16,37 points.