Diagnosis and testing practices for adolescent pertussis among a national sample of primary care physicians.

Child Health Evaluation and Research Unit, University of Michigan, 300 North Ingalls, Ann Arbor, MI 48109-5456, USA.
Preventive Medicine (Impact Factor: 2.93). 04/2009; 48(5):500-4. DOI: 10.1016/j.ypmed.2009.02.020
Source: PubMed

ABSTRACT Adolescents are a primary reservoir for propagating pertussis infection. This study aimed to describe diagnosis and testing practices for adolescent pertussis among a national sample of primary care physicians.
From January to March, 2007 we administered a written survey to a United States sample of American Medical Association physicians that included 725 family practitioners (FPs) and 725 general pediatricians (PDs).
Response rate was 60% (n=702). Overall, 16% of respondents indicated that they did not test adolescents for pertussis as part of their clinical practice. A similar proportion did not recognize the clinical manifestations of pertussis in a standardized adolescent case patient. FPs were less likely than PDs to test for pertussis in general and to diagnose the case patient with pertussis. Barriers to testing adolescents for pertussis included delay in obtaining test results (52%), inconvenience of sample collection (29%), lack of testing supplies (29%), lack of familiarity with testing protocols (28%) and cost (22%).
Our results suggest that a substantial number of primary care physicians do not utilize pertussis testing and may not be able to recognize the clinical symptoms of this infection in adolescents. Interventions to improve physician knowledge about this important public health issue may be warranted.

  • [Show abstract] [Hide abstract]
    ABSTRACT: We retrospectively analyzed the incidence rate of reported cases of pertussis in Barcelona during 2009-2012 according to age, sex, type of medical center and vaccination status. We included 748 confirmed or suspected cases, 613 (82.0%) of which were confirmed by laboratory testing, and the remaining 135 (18.0%) by epidemiological evidence. The highest reported incidence of pertussis was among <1-year-olds (96.1 per 100,000 person-years, 95%CI: 84.3-109.1). The majority of confirmed and suspected cases were reported in 2011 and 2012, and the total incidence (confirmed or suspected) was 6.3 (95%CI: 5.6-6.9) and 4.2 (95%CI: 3.6-4.7) per 100,000 inhabitants, respectively. Incidence increased significantly (p=0.001) in 2011-2012 compared to 2009. Most confirmed cases occurred in children <1 year (87.9%). 87.5% (95%CI: 81.3-87.6) of confirmed cases were confirmed by RT-PCR, and 13.7% (95%CI: 11.0-17.1) by bacterial culture. We recommend performing RT-PCR in suspected cases with no epidemiological link to a confirmed case.
    Journal of Medical Microbiology 09/2014; DOI:10.1099/jmm.0.079756-0 · 2.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To characterize parental attitudes regarding board certification and other factors that influence selection of physicians to care for children. A web-based survey administered in 2008 to a random sample of 3621 adults >or=18 years of age stratified by parents and non-parents. Proportion of respondents who view board certification and other measures of quality as important factors in selecting a physician to care for children. Survey completion rate was 62%. Almost all (95%) believe it is important or very important for doctors who care for children to be assessed on their quality of care, receive high ratings from patients (91%), and pass a written test at regular intervals (88%). Most reported that recommendations from friends or family (84%) and board certification (82%) were important or very important factors in choosing a physician for their child. Seventy-seven percent of parents stated that they would be likely to change their child's physician if he/she did not maintain board certification. Parents report a preference for board-certified physicians and expect them to participate in Maintenance of Certification. Greater understanding of quality measures and the board certification process would empower consumers to make more informed decisions in selecting a physician for their children.
    The Journal of pediatrics 02/2010; 156(5):841-5, 845.e1. DOI:10.1016/j.jpeds.2009.11.055 · 3.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To explore the use and perceived impact of pediatric hospitalists as teaching attendings among pediatric residency and clerkship programs. Between November 2007 and February 2008, the authors conducted a mail-based survey of all pediatric residency program directors (170) and pediatric clerkship directors (131) in the United States as identified by the Association of Pediatric Program Directors and Council on Medical Student Education in Pediatrics. The surveys focused on the responsibilities of pediatric hospitalists in training programs and their perceived impact on the roles of pediatric residents and medical students. The response rate for residency directors was 86% (146/170) and 87% (114/131) for clerkship directors. One hundred thirteen (77%) residency programs and 91 (80%) clerkship programs used hospitalists as teaching attendings. Among these programs, 65% (73) of residency program directors and 64% (58) of clerkship directors reported that pediatric hospitalists are responsible for all general inpatient services. The majority of residency (76%, 84) and clerkship directors (71%, 64) reported that hospitalists are more accessible to trainees than traditional attendings. A minority of residency program directors (36%, 39) reported that use of hospitalists has decreased senior resident autonomy. The role of hospitalists in resident and student education will likely continue to evolve over the next decade.Additional refinement of the roles and responsibilities of hospitalists will address lingering concerns in some programs about resident autonomy.
    Academic medicine: journal of the Association of American Medical Colleges 11/2009; 84(11):1617-21. DOI:10.1097/ACM.0b013e3181bb1f0d · 3.47 Impact Factor