Effect of clinician information sessions on diagnostic testing for Chagas disease

Abstract

Background Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened. Methodology/Principal findings We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11). Conclusion/Significance In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition.

Chagas Disease Diagnostic Testing in Two Academic Hospitals in New Orleans, Louisiana: A Call to Action

“…Despite the signs of Chagas disease’s presence in Louisiana, our results are the first to report the undertesting for Chagas disease from the healthcare system for both the adult and the pediatric population. It is important to determine the undertesting of this disease given that we know that informational sessions can improve the testing frequency of this disease [ 43 ].…”

Chagas Disease Maternal Seroprevalence and Maternal–Fetal Health Outcomes in a Parturition Cohort in Western El Salvador

“…This study was limited by sample size (n = 198 participants) and geographically limited to two western departments. Though these departments both fall under a high index of multidimensional poverty [33], future works should encompass further departments with low socioeconomic status and substandard housing, both being well-established risk factors for Chagas disease infection [14,42,43]. Infant testing results were unavailable for the current study, limiting our knowledge of vertical transmission in this cohort; however, the Ministry of Health is actively performing this testing, ensuring proper treatment of both mothers and any subsequently infected infants.…”