Disease reporting among Georgia physicians and laboratories

Physicians' Knowledge, Practices, and Perceptions of Reporting Communicable Diseases at Primary Health Care Centers in Jeddah, Saudi Arabia: A Cross-Sectional Study

Background Jeddah has the highest international traffic and is among the most diverse cities in Saudi Arabia. The chance of importing an emerging communicable disease is significant, particularly during the religious seasons. Therefore, timely and accurate reporting of communicable diseases at primary health care centers (PHCCs) is crucial. Objectives The main objective of this study was to assess physicians' knowledge, practices, and perceptions of reporting communicable diseases at PHCCs in Jeddah, Saudi Arabia. Methods The study was a cross-sectional study comprising 143 physicians from all PHCCs in Jeddah from October 2017 to February 2018. An electronic questionnaire was used to collect data to assess the physicians' knowledge, practices, and perceptions related to reporting communicable diseases at PHCCs. Results A total of 106 physicians participated in the study. Although only 21.7% of the physicians had received training on reporting communicable diseases, the average knowledge score for the six commonly reported diseases was 72%. More than half (58.5%) of the physicians indicated that they had reported at least one disease. However, there was no agreement on who should be responsible for reporting communicable diseases at PHCCs. Furthermore, some obstacles were perceived that could prevent disease reporting, including physicians not knowing which diseases to report (66%), not knowing how or whom to report to (54.7%), and a limited diagnostic or laboratory capacity (52.8%). Conclusions Reporting communicable diseases at PHCCs was of adequate quality. However, some obstacles must be addressed, and regular applied training must be provided. More extensive assessments are needed to improve the reporting of communicable diseases locally and nationally.

Knowledge and attitude of mandatory infectious disease notification among final year medical students

Background

Disease surveillance is one of the major components to combat against infectious diseases. As health-care professionals are indispensable to mandatory notifiable disease surveillance, their knowledge and attitudes toward infectious disease notification played an important role for timely and effective reporting to the surveillance system. Therefore, we aimed to determine the knowledge of mandatory notifiable infectious diseases in Malaysia and attitude towards infectious disease reporting among final year medical students.

Methods

A cross-sectional study was conducted from May to June 2017 in the private medical college in Malaysia.

Materials and Methods

We purposively selected the final year (semester 10) medical students and a total of 124 students participated in this study. We collected data using a self-administered, structured questionnaire. Data were analyzed using descriptive statistics, independent t-test, and one-way analysis of variance.

Results

Among the final year medical students, 47.5% had moderate knowledge but 4.2% had good knowledge of mandatory infectious disease notification. Only 3.2% of the students correctly answered all the notifiable diseases listed in the questionnaire. Most of the students had positive attitude toward communicable diseases reporting, rewards, and penalty for notification. There was no significant relationship between sociodemographic characteristics and knowledge and attitude of infectious disease notification.

Conclusions

The majority of the final year medical students had moderate level of knowledge and positive attitude of infectious disease notification; however, there were some deficiencies. Better instruction and training on infectious disease notification procedures of Malaysia should be provided to the final year medical students which could not only reduce underreporting but also improve timely and effective reporting in future.

Characteristics of Laws Requiring Physicians to Report Patient Information for Public Health Surveillance: Notable Patterns from a Nevada Case Study

Laws across the globe require healthcare providers to disclose patient health information to public health entities for surveillance and intervention purposes. Physicians play a unique role in such mandatory reporting regimes. However, research reveals consistent under-reporting and points to limited knowledge of mandates, perceived burdens of reporting, misaligned incentives and penalties, and a lack of streamlined processes as significant reporting barriers. These barriers suggest that how legal mandates are structured may impact compliance; yet little research systematically examines their characteristics. Law-based reporting requirements differ across jurisdictions. Thus, we conducted a case study in the U.S. State of Nevada to characterize its physician mandatory reporting laws using legal mapping methodology. Nevada is a useful case study because it has few local jurisdictions and its legislature meets biennially. First, we searched key terms to find relevant state mandates and screened them using inclusion criteria. We then scanned near included provisions for additional requirements and incorporated requirements known a priori. We also searched relevant local regulations. Next, we analyzed all included provisions. Our findings indicate wide, intra-jurisdictional variation in reporting requirements across conditions. Variability extends to physician discretion, information reported, timing, recipient agencies, reporting processes, and implications of non-compliance. Local-level variation adds further complexity. Some relevant state requirements apply only to physicians and nearly one-third were absent from our searches. Our findings support exploring the hypothesis that reporting requirements' characteristics may impact compliance and call for empirically testing such relationships to enhance compliance and public health surveillance and intervention efforts.

Leveraging public health's participation in a Health Information Exchange to improve communicable disease reporting

BACKGROUND

Infectious diseases can appear and spread rapidly. Timely information about disease patterns and trends allows public health agencies to quickly investigate and efficiently contain those diseases. But disease case reporting to public health has traditionally been paper-based, resulting in somewhat slow, burdensome processes. Fortunately, the expanding use of electronic health records and health information exchanges has created opportunities for more rapid, complete, and easily managed case reporting and investigation. To assess how this new service might impact the efficiency and quality of a public health agency's case investigations, we compared the timeliness of usual case investigation to that of case investigations based on case report forms that were partially pre-populated with electronic data.

INTERVENTION

Between September 2013-March 2014, chlamydia disease report forms for certain clinics in Indianapolis were electronically pre-populated with clinical, lab and patient data available through the Indiana Health Information Exchange, then provided to the patient’s doctor. Doctors could then sign the form and deliver it to public health for investigation and population-level disease tracking. Methods: We utilized a novel matched case analysis of timeliness changes in receipt and processing of communicable disease report forms. Each Chlamydia cases reported with the pre-populated form were matched to cases reported in usual ways. We assessed the time from receipt of the case at the public health agency: 1) inclusion of the case into the public health surveillance system and 2) to close to case. A hierarchical random effects model was used to compare mean difference in each outcome between the target cases and the matched cases, with random intercepts for case.

RESULTS

Twenty-one Chlamydia cases were reported to the public health agency using the pre-populated form. Sixteen of these pre-populated form cases were matched to at least one other case, with a mean of 23 matches per case. The mean Reporting Lag for the pre-populated form cases was 2.5 days, which was 2.7 days shorter than the mean Reporting Lag for the matched controls (p = <0.001). The mean time to close a pre-populated form case was 4.7 days, which was 0.2 days shorter than time to close for the matched controls (p = 0.792).

CONCLUSIONS

Use of pre-populated forms significantly decreased the time it took for the local public health agency to begin documenting and closing chlamydia case investigations. Thoughtful use of electronic health data for case reporting may decrease the per-case workload of public health agencies, and improve the timeliness of information about the pattern and spread of disease.

Using an Emergency Department Syndromic Surveillance System to Evaluate Reporting of Potential Rabies Exposures, Illinois, 2013-2015

OBJECTIVES

Mandatory reporting of potential rabies exposures and initiation of postexposure prophylaxis (PEP) allow local health authorities to monitor PEP administration for errors. Our objectives were to use an emergency department (ED) syndromic surveillance system to (1) estimate reporting compliance for exposure to rabies in suburban Cook County, Illinois, and (2) initiate interventions to improve reporting and reassess compliance.

METHODS

We queried ED records from 45 acute care hospitals in Cook County and surrounding areas from January 1, 2013, through June 30, 2015, for chief complaints or discharge diagnoses pertaining to rabies, PEP, or contact with a wild mammal (eg, bat, raccoon, skunk, fox, or coyote). We matched patients with ≥1 ED visit for potential rabies exposure to people with potential rabies exposure reported to the Cook County Department of Public Health. We considered nonmatches to have unreported exposures. We then initiated active surveillance in July 2015, disseminated education on reporting requirements in August and September 2015, and reassessed reporting completeness from July 2015 through February 2016.

RESULTS

Of 248 patients with rabies-related ED visits from January 2013 through June 2015, 63 (25.4%) were reported. After interventions were implemented to increase reporting compliance, 53 of 98 (54.1%) patients with rabies-related ED visits from July 2015 through February 2016 were reported. Patients with ED visits for potential rabies exposure were twice as likely to be reported postintervention than preintervention (risk ratio = 2.1; 95% CI, 1.6-2.8). The volume of potential rabies exposure cases reported to the health department from July 2015 through February 2016 increased by 252% versus the previous year.

CONCLUSIONS

Potential rabies exposures and PEP initiation are underreported in suburban Cook County. ED syndromic surveillance records can be used to estimate reporting compliance and conduct active surveillance.

Notifiable condition reporting practices: implications for public health agency participation in a health information exchange

Background

The future of notifiable condition reporting in the United States is undergoing a transformation with the increasing development of Health Information Exchanges which support electronic data-sharing and -transfer networks and the wider adoption of electronic laboratory reporting. Communicable disease report forms originating in clinics are an important source of surveillance data for public health agencies. However, problems of poor data quality and delayed submission of reports to public health agencies are common. In addition, studies of barriers and facilitators to reporting have assumed that the primary reporter is the treating physician, although the extent to which a provider is involved in the reporting workflow is unclear. We sought to better understand the barriers to and burden of notifiable condition reporting from the perspectives of the three primary groups involved in reporting workflow: providers, clinic staff who bear the principal responsibility for reporting, and the public health workers who receive and process reports from clinics. In addition, we sought to situate these findings within the context of the future of notifiable disease reporting and the potential impacts of electronic lab and medical records on the surveillance system.

Methods

Seven ambulatory care clinics and 3 public health agencies that are part of a Health Information Exchange in the state of Indiana, USA, participated in the study. Data were obtained from a survey of clinic physicians (N = 29), interviews with clinic reporters (N = 11), and interviews with public health workers (N = 9). Survey data were summarized descriptively and interview transcripts underwent qualitative analysis.

Results

In both clinics and public health agencies, the laboratory report initiates reporting workflow. Provider involvement with reporting primarily revolves around ordering medications to treat a condition confirmed by the lab result. In clinics, reporting is typically the responsibility of clinic reporters who vary in frequency of reporting. We found an association between frequency of reporting, reporting knowledge and perceptions of reporting burden. In both clinics and public health agencies, interruptions and delays in reporting workflow are encountered due to inaccurate or missing information and impact reporting timeliness, data quality and report completeness. Both providers and clinic reporters lack clarity regarding how data submitted by their reports are used by public health agencies. It is possible that the value of reporting may be diminished when those responsible do not perceive receiving benefit in return. This may account for the low awareness of or recollection of public health communications with clinics that we observed. Despite the high likelihood that public health advisories and guidance are based, in part, on data submitted by clinics, a direct concordance may not be recognized.

Conclusions

Unlike most studies of notifiable condition reporting, this study included the clinic reporters who bear primary responsibility for completing and submitting reports to public health agencies. A primary barrier to this reporting is timely and easy access to data. It is possible that expanded adoption of electronic health record and laboratory reporting systems will improve access to this data and reduce reporting the burden. However, a complete reliance on automatic electronic extraction of data requires caution and necessitates continued interfacing with clinic reporters for the foreseeable future—particularly for notifiable conditions that are high-impact, uncommon, prone to false positive readings by labs, or are hard to verify. An important finding of this study is the association between frequency of reporting, reporting knowledge and perceptions of reporting burden. Increased automation could result in even lower reporting knowledge and familiarity with reporting requirements which could actually increase reporters’ perception of notifiable condition reporting as burdensome. Another finding was of uncertainty regarding how data sent to public health agencies is used or provides clinical benefit. A strong recommendation generated by these findings is that, given their central role in reporting, clinic reporters are a significant target audience for public health outreach and education that aims to alleviate perceived reporting burden and improve reporting knowledge. In particular, communicating the benefits of public health’s use of the data may reduce a perceived lack of information reciprocity between clinical and public health organizations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4156-4) contains supplementary material, which is available to authorized users.

An overview of disease surveillance and notification system in Nigeria and the roles of clinicians in disease outbreak prevention and control

While outbreaks of infectious diseases have long presented a public health challenge, especially in developing countries like Nigeria; within recent years, the frequency of such outbreaks has risen tremendously. Furthermore, with the recent outbreaks of emerging and re-emerging infectious diseases such as Ebola virus disease and other epidemic prone diseases in Nigeria demanding immediate public health action, there is a need to strengthen the existing notifiable disease surveillance and notification system with increased clinicians’ involvement in timely reporting of notifiable diseases to designated public health authorities for prompt public health action. Hence, this paper provides the opportunity to increase awareness among clinicians on the importance of immediate reporting of notifiable diseases and intensify engagement of clinicians in disease notification activities by describing various notifiable diseases in Nigeria using their surveillance case definition, outlines the reporting channel for notifying these diseases and highlights the roles of clinicians in the current disease surveillance and notification network for early disease outbreak detection and public health response in Nigeria.

Use, location, and timeliness of clinical microbiology testing in Georgia for select infectious diseases

OBJECTIVE

Although clinical microbiology testing facilitates both public health surveillance of infectious diseases and patient care, research on testing patterns is scant. We surveyed hospital laboratories in Georgia to assess their diagnostic testing practices.

METHODS

Using e-mail, all directors of hospital laboratories in Georgia were invited to participate. The survey focused on timing and location of diagnostic testing in 2006 for 6 reportable diseases: giardiasis, legionellosis, meningococcal disease, pertussis, Rocky Mountain spotted fever, and West Nile virus disease.

RESULTS

Of 141 laboratories, 62 (44%) responded to the survey. Hospitals varied widely in their use of diagnostic testing in 2006, with 95.1% testing for meningococcal disease, but only 66.1% and 63.3% testing for legionellosis and West Nile virus disease, respectively. Most laboratories (91%) performed gram stain/culture to diagnose meningococcal disease in-house and 23% performed ova and parasite panels for giardiasis were conducted in-house. Fewer than 11% of laboratories performed in-house testing for the remaining diseases. Laboratories affiliated with small hospitals (≤100 beds) were more likely to send specimens for outside testing compared with laboratories associated with large hospitals (>250 beds). Median turnaround time for ova and parasite panel testing for giardiasis was significantly shorter for in-house testing (1.0 days) than within-system (2.25 days) or outside laboratory (3.0 days) testing (P = .0003). No laboratories reported in-house testing for meningococcal disease, pertussis, or Rocky Mountain spotted fever using polymerase chain reaction.

CONCLUSION

Many hospitals did not order diagnostic tests for important infectious diseases during 2006, even for relatively common diseases. In addition, hospital laboratories were unlikely to perform diagnostic testing in-house; sending specimens to an outside laboratory may result in substantial delays in receiving results. These unsettling findings have adverse implications for both patient care and public health surveillance; they indicate an immediate need to study nationally the use and timeliness of clinical microbiologic testing.