Clinical practice patterns vary between providers, but few studies have examined this variation among infectious disease (ID) physicians. Characterizing these differences in practice can help identify areas where targeted educational interventions or further research are needed to improve clinical decision-making. We describe a faculty survey conducted at our institution designed to identify clinical practice variation within a large academic ID division.
In January 2017, an electronic survey was distributed to all clinical ID faculty at our institution. The survey collected baseline demographic information as well as responses to 28 common clinical dilemmas encountered in routine practice. Descriptive statistics were performed.
Twenty-four (44%) of 54 active clinical ID faculty (12 assistant professors, 6 associate professors, and 6 professors) completed the survey. Examples of clinical dilemmas with >80% agreement among faculty included: 1) S. aureus bacteremia should be a mandatory ID consult (88%) and 2) lumbar puncture should be performed for all patients with suspected ocular syphilis (88%). The majority of clinical dilemmas had less than 80% agreement, and these spanned the range of routine ID practice. Examples included: 1) use of ceftriaxone for outpatient antibiotic therapy for non-bacteremic invasive methicillin-susceptible S. aureus infections (58% agree), 2) length of treatment for guideline-defined uncomplicated S. aureus bacteremia (50% 2 weeks, 50% 4 weeks), 3) use of fixed dose dolutegravir/abacavir/lamivudine as a single drug regimen for an HIV-infected patient with an M184V mutation (42% agree), and 4) benefit of routine anal Pap smears among HIV-infected men who have sex with men (50% agree).
Practice patterns vary between ID physicians within our institution, particularly for clinical dilemmas for which there is insufficient or conflicting published data. Further studies to examine practice pattern variation among ID physicians across institutions and geographic regions could identify areas where further research or educational interventions are needed to enhance clinical care.
V. K. Phadke,