Patients Face Significant Risk of Respiratory Illness Infection in Primary Care Offices

By Christopher Cheney

There is a significant risk of spreading infection of influenza-like illness in primary care offices, a new research article shows.

The potential for the spread of respiratory illness in healthcare settings has been a primary concern during the coronavirus pandemic. To address this concern, many outpatient clinics closed their doors in the early phase of the pandemic and telehealth expanded tremendously to keep patients and their clinicians safely connected for care.

The new research article, which was published by Health Affairs, is based on information collected from a national electronic health records database for patient visits at more than 6,000 office-based primary care practices from 2016 to 2017.

The researchers focused on patient visits for influenza-like illness. Patients were considered potentially exposed to infection if another patient with influenza-like illness was seen in the same clinic as long as 90 minutes before an office visit. Patients who had office visits before another patient with influenza-like illness was seen in the same clinic were considered unexposed. The researchers sought to see whether exposed patients returned to the clinic within two weeks of exposure with influenza-like illness.

The research article features three key data points:

  • The researchers found 2.7 patients per 1,000 returned within two weeks with influenza-like illness, with exposed patients more likely to return with influenza-like illness (an adjusted difference of 0.7 per 1,000 patients)
  • Compared with the baseline rate of a return visit with influenza-like illness for unexposed patients, this change represented a 31.8% increase
  • With more than 7.3 million patients exposed in the study, about 5,140 excess influenza-like illness visits were potentially attributable to appointment timing

“In this study of a large, national EHR dataset, we found that in primary care offices, those seen after a patient with influenza-like illness were more likely to return with a similar illness in the next two weeks compared with nonexposed patients seen earlier in the day,” the research article’s co-authors wrote.

Policy implications

There are two primary healthcare provider policy implications from the study, the research article says.

“First, given that the presence of a symptomatic patient with influenza-like illness is associated with increased rates of likely infection among patients present in the clinic at the same time, healthcare facilities should consider explicit guidelines for the triage to telemedicine of patients with low-risk respiratory viral symptoms such as cough, runny nose, muscle aches, sore throat, or low-grade fever,” the research article’s co-authors wrote.

The second policy implication is that clinics should use strict infection control techniques if patients with influenza-like illness must be seen in person.

“Many infection control practices are standard expectations of care in outpatient settings, as outlined by recommendations from the Centers for Disease Control and Prevention, but compliance with even basic infection control practices such as hand hygiene is notoriously poor. Enhanced infection control practices could include strict requirements for patient mask wearing, which might not be a universal expectation among patients, and immediate cohorting of patients with influenza-like illness into reserved exam rooms that are not shared with other patients before decontamination,” the research article’s co-authors wrote.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.