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Rapid Testing For Influenza
Influenza kills approximately 36,000 people in the United States each year. In addition to the annual toll of seasonal influenza, human fatalities caused by Influenza A virus H5N1 has reinforced the importance of monitoring influenza activity in the United States as part of pandemic preparedness. Several rapid influenza tests have been developed to diagnose influenza far more quickly than can be done with traditional viral cultures. There are eight FDA approved, commercially available waived1 rapid influenza tests that can be used in physician offices, emergency rooms and clinics to diagnose influenza. Although rapid influenza tests do not provide new influenza isolates to the public health system, they may aid in more accurate influenza diagnoses, which can increase the timely provision of antiviral therapy and prophylaxis, and decrease health care costs by minimizing laboratory tests, x-rays and antibiotic use.
This project is evaluating how, and how often, rapid influenza tests are implemented and used in outpatient medical settings (solo and group practice physician offices, community health centers, and acute care hospital emergency departments) throughout the United States; and identifying successful methods for implementing use of rapid influenza testing in a broad range of outpatient medical settings.
Members of the project’s technical advisory panel (TAP), public health officials and outpatient medical care providers will have access to the Wiki that has been created exclusively for this project, to share information and experiences with rapid influenza testing. Information exchanged may include: rationale for test use, problems with the testing process, strategies to overcome problems, staff training, quality assurance activities, and perceived advantages and disadvantages to the tests. The Wiki will also serve as a forum for outpatient care providers and public health officials to share information about their interactions and discuss ways to improve their linkages.
1. Tests can be categorized as "waived" from regulatory oversight if they meet certain requirements including ease of use established by the Clinical Laboratory Improvement Amendments of 1988 (CLIA) law.
Surveys conducted during 1999--2004 by the Centers for Medicare & Medicaid Services and studies funded by CDC during 1999--2003 evaluated testing practices in sites holding a CLIA Certificate of Waiver (CW). Although study findings indicate CW sites generally take measures to perform testing correctly, they raise quality concerns about practices that could lead to errors in testing and poor patient outcomes.
Physician awareness of a rapid diagnosis of influenza in the pediatric emergency department significantly reduced the number of laboratory tests and radiographs ordered and their associated charges, decreased antibiotic use, increased antiviral use, and decreased length of time to discharge.
This is the first evaluation of integrating influenza rapid testing into public health surveillance (Hawaii). Coupling rapid tests with cultures appears to be an effective means of improving influenza surveillance.
Study concludes that rapid influenza testing leads to reductions in antibiotic use in hospitalized adults. Better tools
to rule out concomitant bacterial infection are needed to optimize the impact of viral testing.
When clinicians are planning to use the nonneuraminidase inhibitors
to treat influenza, rapid testing is not the most cost-beneficial approach. Even
when the more expensive neuraminidase inhibitors will be used, testing has a
limited role in managing influenza in high-risk patients.
Survey conducted with Primary Care Physicians (PCPs) identified that 69% of participating PCPs administered influenza tests to patients who had influenza-like illnesses during the influenza season and 53.8% prescribed antiviral agents, including two no longer recommended by CDC (i.e., amantadine & rimantadine).