Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Appendix C: Summary Results of Jefferson County, AL Antiviral Prescribing Survey There were 204 providers who responded to the antiviral prescribing survey. Of the 204, 180 were included in the data analysis. The exclusion criteria eliminated 24 respondents who did not see patients for at least 8 hours per week. Providers who did not see patients with influenza-like illness between the period of October 2008 and April 2009 were redirected to other questions and were included in the final analysis. The majority of the respondents were MDs (48.3%) and nurse practitioners (46.1%). Demographic characteristics are shown in Table 1. Table 1. Characteristics of survey respondents (N = 180) Degree MD/DO Nurse Practitioner Physician Assistant Nursing Home Administer Other N 87 83 4 3 3 Percent 48.3 46.1 2.2 1.7 1.7 Practice Type Family Medicine Internal Medicine Pediatrics OB/GYN Medical Specialty Pediatric Sub-specialty Other 7 12 8 6 22 8 25 8.0 13.6 9.1 6.8 25.0 9.1 39.8 Primary Setting of Practice Outpatient practice (private) Outpatient practice (public) Hospital-based practice Academic/teaching practice Other 61 17 33 47 12 35.9 10.0 18.3 26.1 6.7 Years Since Training 0 – 9 years 10 – 19 years 20 – 29 years 30 – 39 years 40+ years 59 51 30 23 7 34.7 30.0 17.6 13.5 4.1 Number of Patients Seen per Week < 25 per week 25 – 50 per week 51 – 100 per week > 100 per week 33 55 54 28 19.4 32.4 31.8 16.5 Antiviral Treatment The majority of respondents (63.5%; n=108) prescribed antiviral medications for treatment of ILI during the 2008-09 influenza season. Additional data tables are available in Appendix B. Among providers who prescribed antivirals for treatment, 97.3% prescribed oseltamivir, or Tamiflu, 20% prescribed rimantadine, while few prescribed flumadine (12%) and zanamivir (12%). Influenza Testing Although most respondents (75.7%) indicated that their practice performed on-site influenza testing, a sizable minority (24.3%; n=18) did not perform such testing. Prescribing After 48 Hours Slightly less than half of respondents (45.9%) reported “sometimes” or “usually or always” prescribing antivirals more than 48 hours after onset of ILI (Table 2). Most common reasons for prescribing outside of the 48 hour treatment window were: questionable time of onset (48.6%); some efficacy of medication to relieve symptoms after 48 hours (40.0%); and patient requested antiviral medication (25.7%). Table 2. Prescribing frequency after 48 hours of ILI onset N Usually or Always Sometimes Rarely or Never Not applicable 4 30 39 1 Percent 5.4 40.5 52.7 1.4 Antibiotics Approximately 35.7% (n=40) of providers reported prescribing antibiotics to patients with ILI during the 2008-09 influenza season. Of those, 52.5% reported prescribing antibiotics to 0-25% of patients with ILI. The most commonly cited reason for prescribing antibiotics to ILI patients was that the patient had signs/symptoms of secondary bacterial infection (77.5%; n=31) Prophylaxis A notable majority (69.5%; n=116) reported NOT prescribing antivirals for prophylaxis of healthy individuals while 30.5% (n=51) did prescribe antivirals for prophylaxis during the 2008-09 influenza season. The major reason for prescribing was to prevent infection of high-risk family members (71.2%). Knowledge When asked to rate their knowledge of the utility of antiviral medications for treatment of influenza on a scale of 1 (not at all knowledgeable) to 4 (very knowledgeable), a sizable portion (46.6%; n=75) indicated they were somewhat knowledgeable while 26.7% (n=43) indicated they were not very knowledgeable. The mean rating was 2.66. Providers reported using a variety of sources for information about antiviral medications for influenza (Table 3). Table 3. Sources of information about antiviral medications Source Peer-reviewed journals (e.g. JAMA) Mass media Morbidity and Mortality Weekly Report and Recommendations Pharmaceutical company representatives Web-based trainings Conference and meetings Consultations with colleagues Other “Other” responses include: CDC and ADPH VA and AL AMA recommendations Infectious disease consultations N Percent 122 35 66.7 19.1 47 25.7 28 53 81 115 38 15.3 29.0 44.3 62.8 20.8 Additionally, a majority of respondents (83.1%; n=152) indicated that additional recommendations on appropriate use of antiviral medications would be helpful. Preparedness When asked to rate certain aspects of preparedness as strengths at their organization on a scale of 1 (Not a strength) to 5 (Definite strength), respondents rated the Response plan as “adequate” (34.5%; n=60); Response training as “adequate” (36.6%; n=63); Supplies/equipment as “adequate” (31.6%; n=54); Stock of antiviral medications as “not a strength” (28.8%; n=49); and surge capacity as “adequate” (27.3%; n=47). Respondents were asked to rate the level of preparedness of the organization in which they work for a pandemic of influenza on a scale of 1 (Not at all prepared) to 4 (Very prepared) and 38.5% (n=67) indicated a preparedness level of 3 whereas 35.1% (n=61) indicated a preparedness level of 2. The mean rating was 2.4. Lastly, respondents were asked to rate their level of familiarity with the State Pandemic Operational Plan on a scale of 1 (Not at all familiar) to 4 (Very familiar). Many respondents (46.3%; n=82) indicated that they were “not at all familiar” with the Plan whereas 6.2% (n=11) indicated they were very familiar with the Plan. The mean rating was 1.8.