Division of Infectious Disease Boston Children's Hospital, Boston, Massachusetts, United States of America.
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, United States of America.
PLoS Negl Trop Dis. 2022 Jun 16;16(6):e0010524. doi: 10.1371/journal.pntd.0010524. eCollection 2022 Jun.
Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened.
METHODOLOGY/PRINCIPAL FINDINGS: We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11).
CONCLUSION/SIGNIFICANCE: In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition.
恰加斯病是一种潜在危及生命的贫困地区被忽视的疾病，流行于拉丁美洲大陆。它由克氏锥虫（Trypanosoma cruzi，T. cruzi）引起，是美国疾病控制中心确定的需要采取行动的六大寄生虫病之一。据估计，美国有 30 万人感染了 T. cruzi。尽管该病的发病率、死亡率和经济负担很高，但美国许多医疗保健提供者对恰加斯病缺乏认识。本分析的目的是确定在为恰加斯病高危人群服务的社区卫生中心进行信息会议后，进行的诊断检测数量是否增加。次要目的是确定按提供者类型（护士从业者与医生）或筛查患者的专业领域，检测数量是否存在差异。
方法/主要发现：我们对在信息会议前后为临床医生进行恰加斯血清学检测的社区卫生中心数量进行了回顾性数据分析。对东波士顿社区卫生中心（East Boston Neighborhood Health Center，EBNHC）的成人和家庭医学科进行了时间序列分析。在所有科室中，在会议前进行了 1957 次 T. cruzi 检测，在会议后进行了 2623 次。部门间的中断时间序列分析表明，在会议前，检测量随时间保持稳定（前期斜率=每月+4.1；p=0.12），随后在会议后立即发生转变（+51.6；p=0.03），而会议后检测量随时间保持稳定（后期斜率=每月-6.0；p=0.11）。
结论/意义：在这项研究中，信息会议后恰加斯检测增加。在了解到这一干预措施的重要性后开始为其患者检测恰加斯病的临床医生，在他们已经忙碌的工作日中增加了一项额外的、潜在耗时的任务，而没有外部激励或认可。
