Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis
Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis
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DOI：
10.1371/journal.pone.0227890
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发表时间：
2020-01-14
期刊：
影响因子：
3.7
通讯作者：
Hall, Aron J.
中科院分区：
文献类型：
--
作者：
Cardemil, Cristina V.;O'Leary, Sean T.;Hall, Aron J.
背景：诺如病毒是各年龄段急性胃肠炎（AGE）的主要病因；候选疫苗正在临床试验中。虽然诺如病毒诊断检测越来越多，但粪便检测可能无法常规进行，这可能妨碍监测和疾病负担估计。此外，缺乏对疾病负担的了解可能会阻碍提供疫苗的建议，这可能会影响疫苗的覆盖率，并最终影响疫苗的效果。我们的目的是了解医生对AGE门诊患者的粪便检测做法，以及医生对诺如病毒的了解，以便改善监测并为引入疫苗做好准备。方法于2018年1月至3月在全国初级保健儿科医生、家庭医生和普通内科医生网络中进行年龄、诺如病毒和未来诺如病毒疫苗的互联网和邮件调查。结果总有效率为59%（820/1383）。在AGE的高峰期，医生估计他们为15%（四分位数范围：5-33%）的AGE门诊患者安排了粪便检查。据报道，粪便检测对卵和寄生虫、艰难梭状芽孢杆菌和细菌培养物（所有专业的比例为95%）比诺如病毒（所有专业的比例为6% -33%）更常见；即使有诺如病毒特异性检测，也很少要求进行。大多数提供者不知道诺如病毒是所有年龄组AGE的主要原因（儿科医生为80%，家庭医生为86%，普通内科医生为89%），或者含酒精的洗手液对诺如病毒无效（儿科医生为51%，家庭医生为66%，普通内科医生为62%）。未来实施诺如病毒疫苗的主要障碍包括疫苗未被保险覆盖（普通内科64%，儿科医生67%，家庭执业74%）和疫苗接种缺乏足够的报销（儿科医生43%，普通内科46%，家庭执业50%）。提供者认为“根本不是新疫苗引进的障碍”或“次要障碍”的因素包括相信“我的病人不需要这种疫苗”（普通内科78%，家庭内科86%，儿科医生90%）和“我的病人已经接种了太多疫苗”（家庭内科89%，普通内科92%，儿科医生95%）。结论初级保健医师对未来诺如病毒疫苗的引入关注较少，但对诺如病毒的流行和预防手卫生方面的知识存在空白。此外，医生很少要求AGE门诊患者进行粪便检查，这限制了依赖医生指示的粪便诊断的监测估计。缩小医生在诺如病毒负担和传播方面的知识差距有助于支持诺如病毒疫苗的引进。
BackgroundNorovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Additionally, lack of knowledge of the burden of disease may inhibit provider vaccine recommendations, which could affect coverage rates and ultimately the impact of the vaccine. Our objectives were to understand physicians' stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction.MethodsInternet and mail survey on AGE, norovirus, and future norovirus vaccines conducted January to March 2018 among national networks of primary care pediatricians, family practice and general internal medicine physicians.ResultsThe response rate was 59% (820/1383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5-33%) of their outpatients with AGE. Stool tests were reported as more often available for ova and parasites, Clostridioides difficile, and bacterial culture (> 95% for all specialties) than for norovirus (6-33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Pediatricians 80%, Family Practice 86%, General Internal Medicine 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Pediatricians 51%, Family Practice 66%, General Internal Medicine 62%). Concerns cited as major barriers to implementing a future norovirus vaccine included if the vaccine is not covered by insurance (General Internal Medicine 64%, Pediatricians 67%, Family Practice 74%) and lack of adequate reimbursement for vaccination (Pediatricians 43%, General Internal Medicine 46%, Family Practice 50%). Factors that providers believed were 'not at all a barrier' or 'minor barrier' to new vaccine introduction included the belief that "my patients won't need this vaccine" (General Internal Medicine 78%, Family Practice 86%, Pediatricians 90%) and "my patients already get too many vaccines" (Family Practice 89%, General Internal Medicine 92%, Pediatricians 95%).ConclusionsPrimary care physicians had few concerns regarding future norovirus vaccine introduction, but have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Also, physicians infrequently order stool tests for outpatients with AGE, which limits surveillance estimates that rely on physician-ordered stool diagnostics. Closing physician knowledge gaps on norovirus burden and transmission can help support norovirus vaccine introduction.