BACKGROUND: Medically-attended visits for acute respiratory illness (ARI) and influenza-like illness (ILI) are common among school-age children (5-17 years). The crowded school environment serves as an ideal setting for the transmission of influenza and other respiratory viruses, which are easily spread from children to their families. This enhanced spread among children increases the risk of infection for at-risk individuals they may encounter, namely elderly and children younger than 5 years old. We evaluated attendance patterns at a family medicine clinic following the implementation of a school-based influenza surveillance study within the same community to assess whether a reduction in medically-attended visits for school-age children occurred.
METHODS: On January 5, 2015, ORCHARDS (Oregon Child Absenteeism due to Respiratory Disease Study), a school-based influenza surveillance study, was implemented in the Oregon School District (OSD). Home visits were conducted for students with ARI from January 5, 2015 to December 22, 2016. Research staff performed rapid influenza diagnostic tests (RIDT) on nasal specimens from each sick child, and informed parents of the results on the same day. Weekly unique patient visits at five UW family medicine clinics in Madison (2), Verona (1), Belleville (1), and Oregon, Wisconsin (1), were recorded in a clinical data warehouse. The Oregon clinic is attended by residents of OSD. Visits were stratified by age. Weekly patient counts for the period before (July 2007-December 2014) and after ORCHARDS implementation (January 2015- December 2016) were evaluated by age group for each UW clinic.
RESULTS: Weekly visit counts for all age groups at the four clinics surrounding the UW Oregon clinic were consistent from July 2007-July 2016, with no shift in age-stratified visit counts before or after ORCHARDS implementation. Patient visits for school-age children (5-17 years) at the UW Oregon clinic declined significantly in comparison to pre-ORCHARDS levels by 19.4% (Chi-square = 51.7; P<0.001), relative to the other clinics.
CONCLUSIONS: Even with the limitation of low influenza activity over the study period, we observed a dramatic reduction in medically-attended visits for school-age children at the UW Oregon clinic after the implementation of ORCHARDS. This reduction in clinic visits indicates a shift in care-seeking behavior by parents of school-age children, who may view a home visit and subsequent RIDT as an alternative to clinical care. The pattern we observed in the UW Oregon clinic may also provide an opportunity to lessen community exposure to respiratory pathogens within clinics frequented by at-risk individuals.