When to Order a Respiratory Viral Panel (RVP): Physician Use in Clinical Practice

Abstract

Background

Multiplex RVP assays are frequently offered at medical centers to screen for viruses using nucleic acid technology. The University of Pittsburgh Medical Center (UPMC) uses the Genmark eSensor RVP detecting 14 virus types/subtypes. This study evaluated how RVPs are used in a large medical center to better understand physician practices.

Methods

A 32 question, descriptive survey, created using the Qualtrics survey database, was sent via email to pediatric, emergency, internal, and family physicians at large academic hospitals in the UPMC network. The anonymous survey was sent 3 times between January 2017 and March 2017. Survey data were analyzed using the SPSS statistics software.

Results

543/1,265 (43%) survey responses were received; 492 were evaluable. 56% were female; 42% see children, 45% see adults, 13% see both; 16% see patients in the ED. Training levels included 51% residents/fellows and 49% attendings. Of doctors responding, 87% order RVPs. Most (85%) have changed treatment decisions based on a RVP result; 53% changed management ~50% of the time.

Conclusion

Physicians order RVPs most frequently if they believe the results will change treatment. RVPs are ordered more for young and elderly patients, and those with underlying immunosuppression or chronic illness. Cost does not limit physician ordering and most are unaware of it. Suspected influenza or specific virus is also considered.

Disclosures

J. V. Williams, Quidel: Scientific Advisor, Consulting fee GlaxoSmithKline: Scientific Advisor, Consulting fee R. Zimmerman, Sanofi: Grant Investigator, Grant recipient

Patient Characteristics: Presents with influenza like illness and
Fever	+	-		+
RVP ordering frequency	≥ 50% of time	≥ 50% of time		≥ 50% of time
ICU	97%	87%	Infant < 1 mon	79%
Hospitalized organ/bone marrow transplant	97%	89%	Infant 1–24 mon	78%
Hospitalized Chronic Illness	91%	68%	Adults > 65 yrs	83%
Change management:
	+ RVP result, − pneumonia		+ RVP result, + pneumonia
Discontinue antibiotics?	≥ 50% of time		≥ 50% of time
Influenza	82%		29%
Cost:
	+			≤ 50% of time
Knowledge of cost	28%	Does cost influence ordering?		79%

Physicians are more likely to order a RVP if they suspect a certain virus (57%), particularly Influenza (42%). A patient’s Influenza vaccine status is most commonly disregarded in regard to RVP ordering (75%). Physicians ranked impact on medical decision making (to stop or start antimicrobials) as the most important factor influencing RVP ordering (38%).