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Koonin LM, Sliger K, Kerr J, Bullen-Austin L, Graeden E, Farris K, Ionta C, Krause D, Patel A. CDC's Flu on Call Simulation: Testing a National Helpline for Use During an Influenza Pandemic. Health Secur 2021; 18:392-402. [PMID: 33107763 DOI: 10.1089/hs.2019.0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
During an influenza pandemic, healthcare facilities are likely to be filled to capacity, leading to delays in seeing a provider and obtaining treatment. Flu on Call is a collaborative effort between the US Centers for Disease Control and Prevention and partners to develop a toll-free telephone helpline to reduce the burden on healthcare facilities and improve access to antivirals for people who are ill during an influenza pandemic. This study tested the feasibility of Flu on Call during a 1-day simulation using a severe pandemic scenario. Trained volunteer actors placed calls to the helpline using prepared scripts that were precoded for an expected outcome ("disposition") of the call. Scripts represented callers who were ill, those calling for someone else who was ill, and callers who were only seeking information. Information specialists and medical professionals managed the calls. Results demonstrated that Flu on Call may effectively assist callers during a pandemic, increase access to antiviral prescriptions, and direct patients to the appropriate level of care. Overall, 84% of calls exactly matched the expected call disposition; few calls (2%) were undermanaged (eg, the caller was ill but not transferred to a medical professional or received advice from the medical professional that was less intensive than what was warranted). Callers indicated a high level of satisfaction (83% reported their needs were met). Because of the high volume of calls that may be received during a severe pandemic, the Flu on Call platform should evolve to include additional triage channels (eg, through internet, chat, and/or text access).
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Affiliation(s)
- Lisa M Koonin
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Kellye Sliger
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Justin Kerr
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Lisa Bullen-Austin
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Ellie Graeden
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Kevin Farris
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Christopher Ionta
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Diane Krause
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Anita Patel
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
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Lee JJ, Smith M, Bankhead C, Perera Salazar R, Kousoulis AA, Butler CC, Wang K. Oseltamivir and influenza-related complications in children: a retrospective cohort in primary care. Eur Respir J 2020; 56:13993003.02246-2019. [PMID: 32527739 DOI: 10.1183/13993003.02246-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/22/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Influenza and influenza-like illness (ILI) place considerable burden on healthcare systems, especially during influenza epidemics and pandemics. During the 2009/10 H1N1 influenza pandemic, UK national guidelines recommended antiviral medications for patients presenting within 72 h of ILI onset. However, it is not clear whether antiviral treatment was associated with reductions in influenza-related complications. METHODS Our study population consisted of a retrospective cohort of children aged ≤17 years who presented with influenza/ILI at UK primary care practices contributing to the Clinical Practice Research Datalink during the 2009/10 pandemic. We used doubly robust inverse-probability weighted propensity scores and physician prior prescribing instrumental variable methods to estimate the causal effect of oseltamivir prescribing on influenza-related complications. Secondary outcomes were complications requiring intervention, pneumonia, pneumonia or hospitalisation, influenza-related hospitalisation and all-cause hospitalisation. RESULTS We included 16 162 children, of whom 4028 (24.9%) were prescribed oseltamivir, and 753 (4.7%) had recorded complications. Under propensity score analyses oseltamivir prescriptions were associated with reduced influenza-related complications (risk difference (RD) -0.015, 95% CI -0.022--0.008), complications requiring further intervention, pneumonia, pneumonia or hospitalisation and influenza-related hospitalisation, but not all-cause hospitalisation. Adjusted instrumental variable analyses estimated reduced influenza-related complications (RD -0.032, 95% CI -0.051--0.013), pneumonia or hospitalisation, all-cause and influenza-related hospitalisations. CONCLUSIONS Based on causal inference analyses of observational data, oseltamivir treatment in children with influenza/ILI was associated with a small but statistically significant reduction in influenza-related complications during an influenza pandemic.
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Affiliation(s)
- Joseph Jonathan Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Margaret Smith
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rafael Perera Salazar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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