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Effect of a dengue clinical case management course on physician practices in Puerto Rico
  • Published Date:
    Aug 08 2016
  • Source:
    Clin Infect Dis. 63(10):1297-1303.

Public Access Version Available on: November 15, 2017 information icon
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  • Pubmed ID:
  • Pubmed Central ID:
  • Description:

    Prior to 2010, the clinical management of dengue in Puerto Rico was shown to be inconsistent with World Health Organization guidelines. A four-hour classroom-style course on dengue clinical management was developed in 2009 and mandated in 2010 for Puerto Rico medical licensure. Fifty physicians were trained as ‘master trainers’ and gave this course to 7,638 physicians. This study evaluated the effect of the course on the clinical management of hospitalized dengue patients.


    Pre- and post-course test responses from participants were analyzed. Changes in physician practices were assessed by reviewing the medical records of 430 adult and 1075 pediatric dengue patients at the 12 hospitals in Puerto Rico that reported the most cases during 2008–2009 (pre-intervention) and 2011(post-intervention). Mixed-effects logistic regression was used to compare key indicators of dengue management. Key informant interviews of hospital medical directors and department chiefs were conducted to understand reasons for, or barriers to, changes in practice.


    Physician test scores increased from 48% correct to 72% after taking the course. Medical record review showed that the percentage of adult patients who did not receive corticosteroids increased from 30% to 68% (OR 5.9, 95% CI 3.7–9.5) and from 91% to 96% in pediatric patients (OR 2.7, 95% CI 1.5–4.9). Usage of isotonic intravenous saline solutions during the critical period increased from 57% to 90% in adult patients (OR 6.2, 95% CI 1.9–20.4) and from 25% to 44% in pediatric patients (OR 3.4, 95% CI 2.2–5.3). Key informant interviewees attributed improvements in practice to the course and identified additional barriers to further change.


    The management of hospitalized dengue patients improved significantly following implementation of a classroom-style physician training course taught by master trainers. An online version of the course was launched in 2014 to expand its reach and sustainability.

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  • Funding:
    CC999999/Intramural CDC HHS/United States
  • Supporting Files:
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