Healthcare Providers Knowledge and Practices Regarding Enteric Pathogens, West Virginia, 2011

BACKGROUND:  West Virginia suffers from under-reporting of enteric illnesses. Observations from routine disease reporting suggest that providers do not routinely comply with the testing practices recommended in the Infectious Disease Society of America (IDSA) Practice Guidelines for Management of Infectious Diarrhea. To explore contributing factors, a survey was conducted of healthcare providers’ knowledge and practices.

METHODS:  Surveys containing questions on lab testing and patient management practices, and clinical vignettes from the Diagnosis and Management of Foodborne Illnesses were mailed to all licensed MDs, PAs and DOs through the WV Boards of Medicine and Osteopathy.  Responses were entered in an online survey tool and the data was analyzed using Epi Info and Open Epi.

RESULTS:  Of 532 respondents, 389 providers reported actively practicing and reported seeing at least one patient with diarrheal illness in the previous 6 months.  The number of years in practice was evenly distributed among providers.  55% percent of providers utilize lab testing as part of usual management of patients with diarrheal illness; 80% make treatment decisions prior to confirming the cause of diarrhea.  Of those who do not routinely test, over 50% say it would not change their treatment plan, though 15% would test if symptoms persist for several days.  94% report questioning patients regarding risk factors and 47% routinely educate patients on foodborne illnesses/control measures. The most commonly ordered tests for patients with diarrheal illness were C.diff toxin assay, stool culture for bacteria, CBC and chemistry panel. In the clinical vignette section, providers were more likely to give the correct diagnoses in scenarios that were specific to parasitic or bacterial pathogens (26-73%) than scenarios that could have been either bacterial or viral pathogens (7-14%). Providers were also more likely to order appropriate testing for parasitic and bacterial pathogens (24-63%) than appropriate testing to distinguish between bacterial and viral pathogens (3-8%).

CONCLUSIONS:  Several factors affect the under reporting of enteric illnesses in West Virginia. Only half of providers routinely test patients with diarrheal illness, and the vast majority of providers make treatment decisions before confirming the cause of diarrhea.  The providers’ knowledge of enteric pathogens and the testing required to adequately diagnose them is lacking. This coupled with the high rate of treatment prior to confirming the cause of diarrhea could have extremely detrimental effects to patients.  Education is needed for providers on the current IDSA Guidelines and the harm possible by treating patients prior to confirming the cause of diarrhea.