Details:

Alternative Title:
Clin Infect Dis
Personal Author:
Han, George S. ; Gregory, Christopher J. ; Biggerstaff, Brad J. ; Horiuchi, Kalanthe ; Perez, Carmen ; ... More +
Han, George S. ; Gregory, Christopher J. ; Biggerstaff, Brad J. ; Horiuchi, Kalanthe ; Perez, Carmen ; Soto-Gomez, Eunice ; Matos, Desiree ; Margolis, Harold S. ; Tomashek, Kay M. Less -
Description:
Background

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.

Methods

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.

Findings

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.

Interpretation

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.


Subjects:
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Adolescent Adrenal Cortex Hormones Adult Aged Aged, 80 And Over Anti-Inflammatory Agents Article Case Management Child Child, Preschool Dengue Education, Medical, Continuing Female Health Knowledge, Attitudes, Practice Humans Infant Infant, Newborn Isotonic Solutions Male Middle Aged Physicians Practice Patterns, Physicians' Young Adult
Source:
Clin Infect Dis. 63(10):1297-1303
Pubmed ID:
27506689
Pubmed Central ID:
PMC5086272
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States
Place as Subject:
Puerto Rico
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:11db1b72e9197616d3e0b70f919e77afcd035dfcfcb4785f4beafbe3de8627c3
Download URL:
https://stacks.cdc.gov/view/cdc/42700/cdc_42700_DS1.pdf
File Type:

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