On the front lines: family physicians' preparedness for bioterrorism - Original Research

Journal of Family Practice, Sept, 2002 by Frederick M. Chen, John Hickner, Kenneth S. Fink, James M. Galliher, Helen Burstin

* OBJECTIVE The events of September 11, 2001, and the nation's recent experience with anthrax assaults made bioterrorism preparedness a national priority. Because primary care physicians are among the sentinel responders to bioterrorist attacks, we sought to determine family physicians' beliefs about their preparedness for such an attack.

* STUDY DESIGN In October 2001 we conducted a national survey of 976 family physicians randomly selected from the American Academy of Family Physicians' active membership directory.

* POPULATION 614 (63%) family physicians responded to the survey.

* OUTCOMES MEASURED Physicians' self-reported ability to "know what to do as a doctor in the event of a suspected bioterrorist attack, recognize signs and symptoms of an illness due to bioterrorism, and know where to call to report a suspected bioterrorist attack."

* RESULTS Ninety-five percent of physicians agreed that a bioterrorist attack is a real threat within the United States. However, only 27% of family physicians believed that the US health care system could respond effectively to a bioterrorist attack; fewer (17%) thought that their local medical communities could respond effectively. Twenty-six percent of physicians reported that they would know what to do as a doctor in the event of a bioterrorist attack. Only 18% had previous training in bioterrorism preparedness. In a multivariate analysis, physicians' reported that preparedness for a bioterrorist attack was significantly associated with previous bioterrorism preparedness training (OR 3.9 [95% CI 2.4-6.3]) and knowing how to obtain information in the event of a bioterrorist attack (OR 6.4 [95% CI 3.9-10.6]).

* CONCLUSIONS Only one quarter of family physicians felt prepared to respond to a bioterrorist event. However, training in bioterrorism preparedness was significantly associated with physicians' perceived ability to respond effectively to an attack. Primary care physicians need more training in bioterrorism preparedness and easy access to public health and medical information in the event of a bioterrorist attack.

* KEYWORDS Bioterrorism, primary care, public health, disease outbreaks. (J Fam Pract 2002: 51: 745-750)

KEY POINTS FOR CLINICIANS

* Only one quarter of family physicians believe they are prepared to respond to a bioterrorist event.

* Family physicians who have received training in bioterrorism preparedness are more confident than their untrained peers that they would respond effectively to a bioterrorist attack.

* Primary care physicians, who would be on the front line in a bioterrorism attack, should seek training in detection, surveillance, and response activities.

With the events of September 11, 2001, and the anthrax attacks that followed, the once seemingly remote threat of a bioterrorist attack in the United States is now a reality. (1-3) As with infectious disease outbreaks and other public health emergencies, early detection and reporting are critical to a timely and effective response to a bioterrorist event. (4-7) For most Americans, their first point of contact with the health care system is the primary care physician, who is therefore on the front line in this new era of bioterrorism. (8,9) Because victims of a bioterrorist attack may not know they have been affected, and because the symptoms caused by many bioterrorism-related agents mimic those of common conditions, primary care physicians will likely be in the position of diagnosing and managing the initial cases of a bioterrorist-related illness. (10) Physicians' ability to identify cases and activate the public health system are crucial steps in effectively responding to a bioterrorist attack. (6,11,12)

Recent studies have concluded that the preparedness and infrastructure of the public health system are inadequate to deal with a bioterrorist attack and need improvement. (7,13-16) One survey found that fewer than 20% of emergency departments in the Pacific Northwest had plans for responding to a bioterrorist event. (17) While the emphasis on the public health ,system is appropriate, these studies failed to discuss the critical role of primary care providers in responding to bioterrorism. (18-20)

While physician experience with the public health system in managing natural disasters and infectious disease outbreaks may be helpful, the unique features of a bioterrorist attack require that primary care physicians be able to obtain and use information from public health and intelligence sources. (4,21) To date, no studies have assessed primary care physicians' ability to respond to a bioterrorist event. In this national survey we assessed family physicians' personal sense of preparedness for responding to a bioterrorist attack.

METHODS

In March 2001, the National Network for Family Practice and Primary Care Research of the American Academy of Family Physicians (AAFP) conducted 2 focus groups of family physicians to explore the issue of bioterrorism preparedness. Using the results of these focus groups, we designed a 37-item questionnaire to be completed by practicing family physicians. The survey was pilot-tested for clarity by 10 academic family physicians and revised accordingly. The questionnaire used 5-category Likert scales, ranging from "strongly agree" to "strongly disagree" or from "excellent" to "poor," to measure physicians' assessment of bioterrorist risk and preparedness, specific clinical competencies, and their prior level of interaction with the public health system. Physicians were also asked to list 4 biologic agents that might be used in a terrorist attack. Physicians' demographic information, including age, gender, training level, and board certification, was obtained from the membership database of the AAFP. Physician age was divided into 3 categories because of its asymmetric distribution. Physicians were asked to describe their location as meal, urban, or suburban, and to describe the size of the population in their area. Using the physicians' zip codes, we geocoded the respondents to 1 of 4 regions of the country. The study was approved by the Social Science Institutional Review Board at the University of Missouri--Kansas City.