New Mexico Department of Health, Santa Fe, NM.
Ann Emerg Med. 2010 Jan;55(1):32-9. doi: 10.1016/j.annemergmed.2009.09.019.
Influenza causes significant widespread illness each year. Emergency department (ED) clinicians are often first-line providers to evaluate and make treatment decisions for patients presenting with influenza. We sought to better understand ED clinician testing and treatment practices in the Emerging Infections Program Network, a federal, state, and academic collaboration that conducts active surveillance for influenza-associated hospitalizations.
During 2007, a survey was administered to ED clinicians who worked in Emerging Infections Program catchment area hospitals' EDs. The survey encompassed the role of the clinician, years since completing clinical training, hospital type, influenza testing practices, and use of antiviral medications during the 2006 to 2007 influenza season. We examined factors associated with influenza testing and antiviral use.
A total of 1,055 ED clinicians from 123 hospitals responded to the survey. A majority of respondents (85.3%; n=887) reported they had tested their patients for influenza during the 2006 to 2007 influenza season (Emerging Infections Program site range: 59.3 to 100%; P<.0001). When asked about antiviral medications, 55.7% (n=576) of respondents stated they had prescribed antiviral medications to some of their patients in 2006 to 2007 (Emerging Infections Program site range 32.9% to 80.3%; P<.0001). A positive association between influenza testing and prescribing antiviral medications was observed. Additionally, the type of hospital, location in which an ED clinician worked, and the number of years since medical training were associated with prescribing antiviral influenza medications.
There is much heterogeneity in clinician-initiated influenza testing and treatment practices. Additional exploration of the role of hospital testing and treatment policies, clinicians' perception of influenza disease, and methods for educating clinicians about new recommendations is needed to better understand ED clinician testing and treatment decisions, especially in an environment of rapidly changing influenza clinical guidelines. Until influenza testing and treatment guidelines are better promulgated, clinicians may continue to test and treat influenza with inconsistency.
流感每年都会导致广泛的疾病。急诊科（ED）临床医生通常是评估和制定治疗方案的一线提供者，为出现流感症状的患者提供服务。我们试图更好地了解在新兴传染病计划网络（一个联邦、州和学术合作组织，负责对与流感相关的住院病例进行主动监测）中，ED 临床医生的检测和治疗实践。
在 2007 年，对在新兴传染病计划监测区域医院的 ED 工作的 ED 临床医生进行了一项调查。该调查涵盖了临床医生的角色、完成临床培训后的年限、医院类型、流感检测实践以及在 2006 年至 2007 年流感季节使用抗病毒药物的情况。我们研究了与流感检测和抗病毒药物使用相关的因素。
共有 123 家医院的 1055 名 ED 临床医生对该调查做出了回应。大多数受访者（85.3%；n=887）表示，他们在 2006 年至 2007 年流感季节对患者进行了流感检测（新兴传染病计划地点范围：59.3%至 100%；P<.0001）。当被问及抗病毒药物时，55.7%（n=576）的受访者表示，他们在 2006 年至 2007 年期间为一些患者开了抗病毒药物（新兴传染病计划地点范围为 32.9%至 80.3%；P<.0001）。观察到流感检测和开具抗病毒药物之间存在正相关关系。此外，医院类型、ED 临床医生工作地点以及接受医学培训后的年限与开具抗病毒流感药物有关。
临床医生在进行流感检测和治疗方面存在很大的差异。需要进一步探讨医院检测和治疗政策、临床医生对流感疾病的看法以及教育临床医生了解新建议的方法，以更好地了解 ED 临床医生的检测和治疗决策，特别是在流感临床指南不断变化的环境下。在流感检测和治疗指南得到更好的推广之前，临床医生可能会继续以不一致的方式进行流感检测和治疗。
