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Research ArticleMethodology From PBRNS

Rapid Assessment of Agents of Biological Terrorism: Defining the Differential Diagnosis of Inhalational Anthrax Using Electronic Communication in a Practice-Based Research Network

Jonathan L. Temte and Anna Lisa Anderson
The Annals of Family Medicine September 2004, 2 (5) 434-437; DOI: https://doi.org/10.1370/afm.120
Jonathan L. Temte
MD, PhD
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Anna Lisa Anderson
BS
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    Figure 1.

    Accumulation of responses over time. WReN = Wisconsin Research Network; AAFP - American Academy of Family Physicians.

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    Figure 2.

    Distributions of diagnostic categories assigned to cases of inhalational anthrax. AAFP = American Academy of Family Physicians; WReN = Wisconsin Research Network; URI/VS = upper respiratory tract infection/viral syndrome; CNS infect = central nervous system infection; Inf/Bronch = influenza/bronchitis; Pneum = pneumonia.

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    Table 1.

    Comparison of Survey Methods, Response Rates and Times, and Hypothetical Case Management Approaches

    CharacteristicAAFP Survey 5 WReN SurveyPValue
    AAFP = American Academy of Family Physicians; WReN = Wisconsin Research Network; NS = not significant.
    * Total cost of printing, envelopes, and postage divided by number of responses. The associated personnel costs are not included.
    † For case management, we compared responses between the Midwest subset of the AAFP sample (101 physicians, 43 respondents, and 97 responses to cases of inhalational anthrax evaluated) and WReN physicians (62 responses to cases of inhalational anthrax evaluated). Values are percentages of cases for which respondents indicated that they would use that management strategy.
    Survey method
        LocationNationwideWisconsin
        Physicians eligible, No.33,36560
        Physicians sent survey instruments, No.66255
        Method of survey distributionSent by conventional mail with self- addressed, stamped response postcardSent by e-mail with instructions to reply by e-mail
        Distributions, No.32
        Time between distributions, days217
        Direct cost per response, $*5.59Nominal
    Response rate and time
        Physicians responding, No. (%)245 (37.0)26 (47.3)NS
        Range of response times, days7–1721–21
        Median response time, days282<.0001
    Case management†
        Hospitalize the patient, %62.962.7NS
        Obtain a chest radiograph, %84.286.7NS
        Obtain a specimen for blood culture, %55.245.9NS
        Initiate empiric antibiotic therapy, %58.845.9NS

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    In cases of bioterrorism, primary care doctors need to diagnose diseases that are rare and that may resemble other, more common diseases. Practice-based research networks (PBRNs) are groups of primary care practices that join together to conduct research in the medical office setting. PBRNs in which the doctors can be contacted by e-mail are well-suited to identify and deal with bioterrorism. They can play an important role in gathering data quickly and providing early detection of bioterrorism.

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The Annals of Family Medicine: 2 (5)
The Annals of Family Medicine: 2 (5)
Vol. 2, Issue 5
1 Sep 2004
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Rapid Assessment of Agents of Biological Terrorism: Defining the Differential Diagnosis of Inhalational Anthrax Using Electronic Communication in a Practice-Based Research Network
Jonathan L. Temte, Anna Lisa Anderson
The Annals of Family Medicine Sep 2004, 2 (5) 434-437; DOI: 10.1370/afm.120

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Rapid Assessment of Agents of Biological Terrorism: Defining the Differential Diagnosis of Inhalational Anthrax Using Electronic Communication in a Practice-Based Research Network
Jonathan L. Temte, Anna Lisa Anderson
The Annals of Family Medicine Sep 2004, 2 (5) 434-437; DOI: 10.1370/afm.120
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