Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis.
<h4>Background</h4>Norovirus 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...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2020-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0227890 |
| _version_ | 1818583815446069248 |
|---|---|
| author | Cristina V Cardemil Sean T O'Leary Brenda L Beaty Katy Ivey Megan C Lindley Allison Kempe Lori A Crane Laura P Hurley Michaela Brtnikova Aron J Hall |
| author_facet | Cristina V Cardemil Sean T O'Leary Brenda L Beaty Katy Ivey Megan C Lindley Allison Kempe Lori A Crane Laura P Hurley Michaela Brtnikova Aron J Hall |
| author_sort | Cristina V Cardemil |
| collection | DOAJ |
| description | <h4>Background</h4>Norovirus 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.<h4>Methods</h4>Internet 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.<h4>Results</h4>The 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%).<h4>Conclusions</h4>Primary 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. |
| first_indexed | 2024-12-16T08:11:17Z |
| format | Article |
| id | doaj.art-6cd8d5631ddc4e4bb4338e2709f4efa5 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-16T08:11:17Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-6cd8d5631ddc4e4bb4338e2709f4efa52022-12-21T22:38:21ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01151e022789010.1371/journal.pone.0227890Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis.Cristina V CardemilSean T O'LearyBrenda L BeatyKaty IveyMegan C LindleyAllison KempeLori A CraneLaura P HurleyMichaela BrtnikovaAron J Hall<h4>Background</h4>Norovirus 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.<h4>Methods</h4>Internet 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.<h4>Results</h4>The 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%).<h4>Conclusions</h4>Primary 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.https://doi.org/10.1371/journal.pone.0227890 |
| spellingShingle | Cristina V Cardemil Sean T O'Leary Brenda L Beaty Katy Ivey Megan C Lindley Allison Kempe Lori A Crane Laura P Hurley Michaela Brtnikova Aron J Hall Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis. PLoS ONE |
| title | Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis. |
| title_full | Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis. |
| title_fullStr | Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis. |
| title_full_unstemmed | Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis. |
| title_short | Primary care physician knowledge, attitudes, and diagnostic testing practices for norovirus and acute gastroenteritis. |
| title_sort | primary care physician knowledge attitudes and diagnostic testing practices for norovirus and acute gastroenteritis |
| url | https://doi.org/10.1371/journal.pone.0227890 |
| work_keys_str_mv | AT cristinavcardemil primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT seantoleary primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT brendalbeaty primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT katyivey primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT meganclindley primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT allisonkempe primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT loriacrane primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT lauraphurley primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT michaelabrtnikova primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis AT aronjhall primarycarephysicianknowledgeattitudesanddiagnostictestingpracticesfornorovirusandacutegastroenteritis |