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Do pediatricians manage influenza differently than internists?
Michael B Rothberg1, Aleta B Bonner, M H Rajab
1Department of Medicine, Baystate Medical Center, Springfield, MA, USA. Michael.Rothberg@bhs.org
Insights
Pediatricians utilize rapid influenza testing and antiviral medications more frequently than internists. Specific guidelines are needed for managing pediatric and adult influenza cases.
Area of Science:
- Infectious Diseases
- Pediatrics
- Internal Medicine
Background:
- Limited understanding of how pediatricians and internists manage influenza symptoms.
- Current Centers for Disease Control and Prevention (CDC) guidelines for antiviral prescribing do not differentiate between adults and children.
- Need to describe and compare influenza management strategies between pediatricians and internists.
Purpose of the Study:
- To describe how pediatricians manage influenza in two academic medical institutions.
- To compare the influenza management practices of pediatricians with those of internists.
Main Methods:
- Cross-sectional online survey of physician knowledge, attitudes, and practices regarding influenza diagnosis and antiviral therapy.
- Survey conducted at the end of the 2003-4 influenza season at two large academic medical centers.
- Data collected on demographics, rapid diagnostic testing use, antiviral prescribing patterns, and beliefs about influenza and antiviral drugs.
Main Results:
- Pediatricians were more likely than internists to perform rapid influenza testing (74% vs. 47%).
- Pediatricians were more likely to use amantadine (88% vs. 48%) and restrict prescribing to high-risk patients (86% vs. 53%).
- Pediatricians were more likely to believe antiviral therapy could decrease mortality (38% vs. 22%), while internists were less familiar with or lacked access to rapid testing.
Conclusions:
- Significant differences exist in how pediatricians and internists manage influenza.
- Development of evidence-based guidelines tailored to the specific needs of pediatric and adult patient populations is recommended.
- Further research may elucidate optimal influenza management strategies for different age groups.
Background:
Little is known about how pediatricians or internists manage influenza symptoms. Recent guidelines on antiviral prescribing by the Centers for Disease Control and Prevention (CDC) make almost no distinction between adults and children. Our objective was to describe how pediatricians in two large academic medical institutions manage influenza and compare them to internists.
Methods:
At the end of the 2003-4 influenza season, we conducted a cross sectional on-line survey of physician knowledge, attitudes and practices regarding rapid diagnostic testing and use of antiviral therapy for influenza at two large academic medical centers, one in Massachusetts and the other in Texas. We collected data on self-reported demographics, test use, prescribing practices, and beliefs about influenza and anti-influenza drugs.
Results:
A total of 107 pediatricians and 103 internists completed the survey (response rate of 53%). Compared to internists, pediatricians were more likely to perform rapid testing (74% vs. 47%, p < 0.0001), to use amantadine (88% vs. 48%, p < 0.0001), to restrict their prescribing to high-risk patients (86% vs. 53%, p < 0.0001), and to believe that antiviral therapy could decrease mortality (38% vs. 22%, p = 0.01). Other beliefs about antiviral therapy did not differ statistically between the specialties. Internists were more likely to be unfamiliar with rapid testing or not to have it available.
Conclusion:
Pediatricians and internists manage influenza differently. Evidence-based guidelines addressing the specific concerns of each group would be helpful.
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