1
|
Chen D, Gonzales E, Winget M, Shaw J, Artandi M, Tsai SA, Nelligan I. Evaluation of video visit appropriateness for common symptoms seen in primary care: A retrospective cohort study. J Telemed Telecare 2024:1357633X231224094. [PMID: 38254267 DOI: 10.1177/1357633x231224094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Little is known about which conditions seen in primary care are appropriate for video visits. This study evaluated video visits compared to office visits for six conditions: abdominal pain, joint pain, back pain, headache, chest pain, and dizziness. METHODS Six hundred charts of adult patients from our institution's same-day outpatient clinic were reviewed in this study. Charts for video visits evaluating the aforementioned chief complaints that occurred between August and October 2020 were reviewed and compared with charts for office visits that occurred from August to September 2019. Frequencies of 3-week follow-up visits, Emergency Room visits, imaging, and referrals for office and video visits were measured. Reasons for in-person evaluation for patients seen by video were determined by review of clinician notes. RESULTS Three-week in-person follow-up was more frequent for patients presenting with chest pain (52% vs 18%, p = 0.0007) and joint pain (24% vs 8%, p = 0.05) after video evaluation, relative to an office evaluation. Three-week in-person follow-up was also more frequent for patients presenting with dizziness (38% vs 28%) and low back pain (24% vs 14%); however, this difference was not statistically significant. Patients presenting with headache and abdominal pain did not have a higher rate of follow-up. DISCUSSION Based on the frequency of in-person follow-up, this study suggests that video visits are generally adequate for evaluating headache and abdominal pain. Patients with dizziness and chest pain have the highest frequency of in-person and Emergency Room follow-up within 3 weeks when first seen by video compared to other conditions evaluated and may be less suitable for an initial video visit. Institutions can consider these findings when scheduling and providing guidance to patients on what type of visit is most appropriate for their symptoms.
Collapse
Affiliation(s)
- Doris Chen
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Elyse Gonzales
- Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Marcy Winget
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan Shaw
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Maja Artandi
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Sandra A Tsai
- Department of Medicine, Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Ian Nelligan
- Department of Primary Care, San Francisco Free Clinic, San Francisco, California, USA
| |
Collapse
|
2
|
Ong’uti SK, Artandi M, Betts B, Weng Y, Desai M, Lentz C, Nelligan I, Ha DR, Holubar MK. A quality-improvement approach to urgent-care antibiotic stewardship for respiratory tract infections during the COVID-19 pandemic: Lessons learned. Infect Control Hosp Epidemiol 2023; 44:2022-2027. [PMID: 36815249 PMCID: PMC10445104 DOI: 10.1017/ice.2023.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVE We investigated a decrease in antibiotic prescribing for respiratory illnesses in 2 academic urgent-care clinics during the coronavirus disease 2019 (COVID-19) pandemic using semistructured clinician interviews. METHODS We conducted a quality-improvement project from November 2020 to May 2021. We investigated provider antibiotic decision making using a mixed-methods explanatory design including interviews. We analyzed transcripts using a thematic framework approach to identify emergent themes. Our performance measure was antibiotic prescribing rate (APR) for encounters with respiratory diagnosis billing codes. We extracted billing and prescribing data from the electronic medical record and assessed differences using run charts, p charts and generalized linear regression. RESULTS We observed significant reductions in the APR early during the COVID-19 pandemic (relative risk [RR], 0.20; 95% confidence interval [CI], 0.17-0.25), which was maintained over the study period (P < .001). The average APRs were 14% before the COVID-19 pandemic, 4% during the QI project, and 7% after the project. All providers prescribed less antibiotics for respiratory encounters during COVID-19, but only 25% felt their practice had changed. Themes from provider interviews included changing patient expectations and provider approach to respiratory encounters during COVID-19, the impact of increased telemedicine encounters, and the changing epidemiology of non-COVID-19 respiratory infections. CONCLUSIONS Our findings suggest that the decrease in APR was likely multifactorial. The average APR decreased significantly during the pandemic. Although the APR was slightly higher after the QI project, it did not reach prepandemic levels. Future studies should explore how these factors, including changing patient expectations, can be leveraged to improve urgent-care antibiotic stewardship.
Collapse
Affiliation(s)
| | - Maja Artandi
- Express Care, Stanford Health Care, Stanford, California
| | - Brooke Betts
- Department of Pharmacy, Stanford Health Care, Stanford, California
| | - Yingjie Weng
- Quantitative Sciences Unit, Stanford University School of Medicine
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University School of Medicine
- Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, California
| | | | - Ian Nelligan
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - David R. Ha
- Department of Quality, Patient Safety and Effectiveness, Stanford Health Care, Stanford, California
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California
| | - Marisa K. Holubar
- Department of Quality, Patient Safety and Effectiveness, Stanford Health Care, Stanford, California
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
3
|
Ha D, Ong’uti S, Chang A, Mui E, Nelligan I, Betts B, Lentz C, Alegria W, Fox E, Meng L, Stenehjem E, Hersh AL, Deresinski S, Artandi M, Holubar M. Sustained Reduction in Urgent Care Antibiotic Prescribing During the COVID-19 pandemic: An Academic Medical Center’s Experience. Open Forum Infect Dis 2022; 9:ofab662. [PMID: 35111874 PMCID: PMC8802794 DOI: 10.1093/ofid/ofab662] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
We compared antibiotic prescribing before and during the coronavirus disease 2019 (COVID-19) pandemic at 2 academic urgent care clinics and found a sustained decrease in prescribing driven by respiratory encounters and despite transitioning to telemedicine. Antibiotics were rarely prescribed during encounters for COVID-19 or COVID-19 symptoms. COVID-19 revealed opportunities for outpatient stewardship programs.
Collapse
Affiliation(s)
- David Ha
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| | - Sharon Ong’uti
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| | - Amy Chang
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| | - Emily Mui
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| | - Ian Nelligan
- Primary Care and Population Health, Stanford, California, USA
| | - Brooke Betts
- Department of Pharmacy, Stanford Health Care, Stanford, California, USA
| | | | - William Alegria
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| | - Emily Fox
- Department of Pharmacy, Stanford Health Care, Stanford, California, USA
| | - Lina Meng
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Stanley Deresinski
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| | - Maja Artandi
- Express Care, Stanford Health Care, Stanford, California, USA
| | - Marisa Holubar
- Stanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, California, USA
| |
Collapse
|
4
|
Betts B, Ha DR, Holubar M, Holubar M, Artandi M, Onguti S, Nelligan I. 160. Urgent Care Prescriber Perspectives on Antibiotic Prescribing During the COVID-19 Pandemic. Open Forum Infect Dis 2021. [PMCID: PMC8645035 DOI: 10.1093/ofid/ofab466.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Urgent care practices were significantly impacted by the COVID-19 pandemic. Studies conducted early in the pandemic demonstrated dramatic decreases in outpatient antibiotic prescribing, particularly amongst agents typically used for respiratory infections. We observed a 33% decline in urgent care antibiotics prescribing during the COVID-19 pandemic in our urgent care clinics. We investigated the prescriber experience to elucidate factors influencing antibiotic use for respiratory conditions during the COVID-19 pandemic at two academic urgent care clinics. Methods We employed a mix method approach, first distributing a survey to all full-time prescribers. We then followed up with qualitative interviews (12 of 22 prescribers) which was conducted by a single, trained interviewer using a standardized guide. Interviews were recorded and transcribed verbatim. Each transcription was independently reviewed and coded by two blinded investigators using standardized themes and adjudicated by a third investigator for stability, robustness, and interrater reliability. Individually, researchers identified and coded key themes and statements. These themes were then discussed as a group and combined where they shared meaning. This project was reviewed and deemed to be non-human subjects research by the Stanford University School of Medicine Panel on Human Subjects in Medical Research. Results A total of 20 of the 22 prescribers (13 MDs and 9 APPs) completed the survey (91% response rate). Notably, only 25% of prescribers agreed that COVID-19 had changed their antibiotic prescribing practices for patients with respiratory infections despite objective data that all prescribed less. In the qualitative interviews, we identified four major themes impacting the appropriateness of antibiotic prescribing practices as shown in Table 1. ![]()
Conclusion Urgent care prescribers attributed a decrease in antibiotic prescribing during COVID-19 to changes in patient expectations and knowledge base, a switch to telemedicine-based encounters, and changing epidemiology. These shifts could be utilized by outpatient antimicrobial stewardship efforts to sustain low prescribing rates for conditions in which antibiotics are generally not indicated. Disclosures Marisa Holubar, MD, MS, Nothing to disclose
Collapse
Affiliation(s)
| | - David R Ha
- Stanford Antimicrobial Safety and Sustainability Program, Stanford, California
| | | | | | | | | | | |
Collapse
|
5
|
Srinivasan M, Asch S, Vilendrer S, Thomas SC, Bajra R, Barman L, Edwards LM, Filipowicz H, Giang L, Jee O, Mahoney M, Nelligan I, Phadke AJ, Torres E, Artandi M. Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center. Ann Intern Med 2020; 173:527-535. [PMID: 32628536 PMCID: PMC7370832 DOI: 10.7326/m20-1814] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits. OBJECTIVE To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits. DESIGN Semistructured qualitative interviews. SETTING 6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019. PARTICIPANTS 53 program participants (overlapping roles as medical providers [n = 20], medical assistants [n = 16], nurses [n = 4], technologists [n = 4], and administrators [n = 13]) were interviewed about video visit transition and challenges. INTERVENTION In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method. MEASUREMENTS 9 faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used. RESULTS The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization. LIMITATIONS Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability. CONCLUSION After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being. PRIMARY FUNDING SOURCE Stanford Department of Medicine and Stanford Health Care.
Collapse
Affiliation(s)
- Malathi Srinivasan
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Steven Asch
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Stacie Vilendrer
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Samuel Crandall Thomas
- Stanford University School of Medicine and Intermountain Delivery Institute, Intermountain Healthcare, Palo Alto, California (S.C.T.)
| | - Rika Bajra
- Stanford University School of Medicine, Portola Valley, California (R.B.)
| | - Linda Barman
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | | | | | - Lena Giang
- Stanford Health Care, Palo Alto, California (H.F., L.G.)
| | - Olivia Jee
- Stanford University School of Medicine, Los Altos, California (L.M.E., O.J.)
| | - Megan Mahoney
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Ian Nelligan
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Anuradha Jayant Phadke
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| | - Elise Torres
- Stanford University School of Medicine, Santa Clara, California (E.T.)
| | - Maja Artandi
- Stanford University School of Medicine, Palo Alto, California (M.S., S.A., S.V., L.B., M.M., I.N., A.J.P., M.A.)
| |
Collapse
|
6
|
Nelligan I, Montacute T, Browne MA, Lin S. Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan. Fam Med 2020; 52:417-421. [PMID: 32520375 DOI: 10.22454/fammed.2020.334308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians. METHODS We examined claims data for procedures performed on patients insured under our AMC's home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI). RESULTS Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33. CONCLUSION A family medicine minor procedure service significantly lowered health spending at our AMC.
Collapse
Affiliation(s)
- Ian Nelligan
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Tamara Montacute
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine
| |
Collapse
|
7
|
Gidwani R, Nguyen C, Kofoed A, Carragee C, Rydel T, Nelligan I, Sattler A, Mahoney M, Lin S. Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial. Ann Fam Med 2017; 15:427-433. [PMID: 28893812 PMCID: PMC5593725 DOI: 10.1370/afm.2122] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/15/2017] [Accepted: 05/03/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency. METHODS We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close. RESULTS Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028). CONCLUSIONS To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout.
Collapse
Affiliation(s)
- Risha Gidwani
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford University, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Cathina Nguyen
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Alexis Kofoed
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Catherine Carragee
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Tracy Rydel
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Ian Nelligan
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Amelia Sattler
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Megan Mahoney
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| |
Collapse
|
8
|
Lin S, Osborn K, Sattler A, Nelligan I, Svec D, Aaronson A, Schillinger E. Creating the medical school of the future through incremental curricular transformation: the Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD). Education for Primary Care 2016; 28:180-184. [PMID: 27892817 DOI: 10.1080/14739879.2016.1259965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kim Osborn
- MD Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Amelia Sattler
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ian Nelligan
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David Svec
- Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alistair Aaronson
- Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Erika Schillinger
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
9
|
Oria PA, Matini W, Nelligan I, Emukule G, Scherzer M, Oyier B, Ochieng HN, Hooper L, Kanyuga A, Muthoka P, Morales KF, Nzioka C, Breiman RF, Katz MA. Are Kenyan healthcare workers willing to receive the pandemic influenza vaccine? Results from a cross-sectional survey of healthcare workers in Kenya about knowledge, attitudes and practices concerning infection with and vaccination against 2009 pandemic influenza A (H1N1), 2010. Vaccine 2011; 29:3617-22. [PMID: 21296117 DOI: 10.1016/j.vaccine.2011.01.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/28/2010] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
Abstract
Over 1200 cases of 2009 pandemic influenza A H1N1 (pH1N1) have been identified in Kenya since the first case in June 2009. In April 2010 the Kenyan government launched a program to immunize high-risk groups and healthcare workers (HCWs) with pH1N1 vaccines donated by the World Health Organization. To characterize HCWs' knowledge, attitudes and practices regarding pH1N1 vaccination, we conducted a quantitative and qualitative survey in 20 healthcare facilities across Kenya between January 11 and 26, 2010. Of 659 HCWs interviewed, 55% thought there was a vaccine against pH1N1, and 89% indicated that they would receive pH1N1 vaccine if it became available. In focus group discussions, many HCWs said that pH1N1 virus infection did not cause severe disease in Kenyans and questioned the need for vaccination. However, most were willing to accept vaccination if they had adequate information on safety and efficacy. In order for the influenza vaccination campaign to be successful, HCWs must understand that pH1N1 can cause severe disease in Kenyans, that pH1N1 vaccination can prevent HCWs from transmitting influenza to their patients, and that the vaccine has been widely used globally with few recognized adverse events.
Collapse
Affiliation(s)
- Prisca A Oria
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC-Kenya), Nairobi, Kenya.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Watson TG, Nelligan I, Lessing L. Further support for fed-batch production of cellulases. Biotechnol Lett 1986. [DOI: 10.1007/bf01030500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
11
|
|
12
|
|
13
|
|