Rapid influenza diagnostic test use and antiviral prescriptions in outpatient settings pre- and post-2009 H1N1 pandemic.

BACKGROUND: Rapid influenza diagnostic tests (RIDTs) can be used at the point-of-care and are often the only influenza tests readily available in outpatient facilities. OBJECTIVES: To determine the use of RIDTs and antiviral prescription practices in outpatient facilities. STUDY DESIGN: Surveys were mailed to U.S. physician's offices, emergency departments, and community health centers in 2008 (pre-2009 H1N1 pandemic) and 2010 (post-2009 H1N1 pandemic). The 2010 survey included questions to evaluate changes in testing and treatment practices among various risk groups subsequent to the 2009 H1N1 pandemic. RESULTS: In both surveys, respondents using RIDTs relied on RIDT results to guide prescribing antiviral medications. Greater than two-thirds of these respondents reported prescribing antiviral medications both pre- and post-pandemic for patients within 48h of onset of flu-like symptoms with a positive RIDT (69% pre-pandemic; 67% post-pandemic). After the pandemic (2010 survey), outpatient providers also reported prescribing antivirals to those with flu-like symptoms for 31% of children <2 years, 23% of children 2-5 years, 37% of pregnant patients, and 74% of other patients at high risk; while these figures were higher than pre-pandemic, they represent a failure to use CDC guidelines to prescribe antivirals for patients with suspected influenza who are at higher risk for complications. CONCLUSIONS: Clinicians in outpatient facilities often relied on RIDT findings to aid in making antiviral treatment decisions; however their treatment practices were not always consistent with CDC guidelines. The use of RIDTs and antiviral medicines were influenced by the 2009 H1N1 pandemic.

Language services in hospitals: discordance in availability and staff use.

Despite efforts to advance effective patient-provider communication, many patients' language needs continue to be unmet or inappropriately addressed by healthcare providers (Wielawski 2010; Patek et al. 2009; Wilson-Stronks and Galvez 2007). This study presents a picture of the language resources currently provided by hospitals and those resources practitioners actually use. Questionnaire data were collected from 14 hospitals in Florida's Palm Beach, St. Lucie, and Martin counties on availability, staff awareness, and staff use of linguistic resources and services. Inconsistencies were identified between the language tools, services, and resources hospitals provide and those staff use. In addition, a large majority of staff respondents still rely upon someone accompanying the patient for communication with patients who have limited English proficiency, despite evidence that this practice contributes to miscommunication and serious medical errors (Flores et al. 2003; Flores 2005; HHS OMH 2001; Patek et al. 2009). Hospitals that use bilingual staff as interpreters often do not test the competency of these staff, nor do they assess the utilization or effectiveness of the tools and resources they provide. Hospitals can improve the cultural and linguistic care they provide if they (1) address the practice of using ad hoc interpreters, (2) effectively disseminate information to hospital staff regarding how and when to access available resources, and (3) collect patient population data and use it to plan for and evaluate the language services they provide to their patients.