An Assessment of El Paso Physician Knowledge, Attitudes, and Practices Regarding the Clinical Management of Suspected Cases of Pertussis Open Access

Everitt, Ian Kyle (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/tx31qj01b?locale=en
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Abstract

Background and Significance: Despite an observed increase in the incidence of pertussis in the El Paso, Texas, there is little quantifiable data to characterize ongoing transmission of pertussis infection. The collection of data, conduction of epidemiologic surveillance, and implementation of public health action in the region is complicated by a variety of unique geopolitical, social, cultural, and economic challenges. There is concern that the collection and interpretation of pertussis case data is hampered by inappropriate confirmatory testing and inadequate case reporting among El Paso physicians who encounter suspected cases of pertussis. Because limited information exists regarding the association between pertussis-related knowledge and attitudes and subsequent pertussis clinical management and confirmatory testing practices, obtaining this information is vital to understanding the factors that influence diagnostic testing and timely reporting of notifiable disease in El Paso.

Methods: An assessment of knowledge, attitudes, and practices was distributed to 123 physicians in El Paso, Texas. Multivariate logistic regression was used to assess and quantify the extent to which physician knowledge of pertussis disease and clinical management predict pertussis diagnostic testing practices. Additional analyses were conducted to inform future interventions by determining other factors that impact physician behavior and identify existing gaps in pertussis-related knowledge.

Results: Better knowledge of pertussis case definitions and clinical management was not significantly associated with conducting appropriate tests to confirm pertussis infection. Physician specialty, clinical practice setting, and country of medical education were associated with pertussis testing practices, although inappropriate testing practices were prevalent even among physicians who had extensive experience diagnosing cases of pertussis infection.

Discussion and Conclusions: Increasing pertussis-related knowledge among El Paso physicians may be effective in promoting appropriate confirmatory testing of pertussis infection. Although testing behavior is more strongly associated with other factors such as clinical specialty and inpatient versus outpatient work settings, these factors are not amenable to change through intervention. Education is needed in all groups, although targeted interventions aimed at improving the utilization of PCR to confirm suspected cases of pertussis is especially needed for physicians of non-pediatric specialties, who may be less likely to suspect and diagnose pertussis infections.

Table of Contents

INTRODUCTION..........................................................................1

The United States-Mexico Border Region..........................................1

Health Challenges in the Paso del Norte Metropolitan Area..................5

Pertussis Disease...........................................................................6

Pertussis Vaccination......................................................................8

Pertussis Re-emergence in the United States.....................................10

Public Health Reporting of Pertussis in El Paso...................................12

Research Justification and Significance.............................................15

Specific Aims................................................................................16

METHODS....................................................................................17

Research Context..........................................................................17

KAP Assessment Tool Development..................................................18

Survey Administration and Data Collection........................................19

Data Analysis................................................................................21

Score Construction .......................................... ............................... 21 Descriptive Statistics .......................................... ............................ 22 Bivariate Analyses .......................................... ................................ 23

Multivariate Analyses and Model Construction ..................................... 24

Exploring Additional Targets for Intervention ...................................... 26

RESULTS......................................................................................28

Demographic Characteristics............................................................28

Physician Experience with Pertussis..................................................29

Pertussis Knowledge, Attitudes, and Practices: Descriptive Statistics.....30

Bivariate Analyses..........................................................................33

Multivariate Analyses......................................................................35

DISCUSSION................................................................................37

Knowledge, Attitudes, and Practices..................................................37

Knowledge as a Predictor of Pertussis Testing Practices........................38

Potential Targets for Physician-Based Intervention...............................39

CONCLUSIONS & RECOMMENDATIONS.........................................42

Strengths and Limitations................................................................42

Conclusions and Recommendations...................................................45

REFERENCES.................................................................................49

TABLES & FIGURES ......................................... .............................. 53

APPENDICES.................................................................................67

Appendix 1: Assessment Tool............................................................67

Appendix 2: Informed Consent Document...........................................71

Appendix 3: Report of Findings .......................................................... 72

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