Partners in Sentinel Health Partners in Sentinel Health SurveillanceSurveillance2003-20042003-2004

TARRANT Annual MeetingTARRANT Annual MeetingFebruary 24, 2005February 24, 2005

National Research System (NaReS) Staff

Jamie Jensen - FluWatch Coordinator Anita Lambert-Lanning - Research Information Coordinator (NaReS)

LA/

NaReS FluWatch Sentinel Provinces

I

http://www.hc-sc.gc.ca/pphb-dgspsp/fluwatch/index.html

FluWatch Program Partners and System Flow Chart

Centre for InfectiousDisease

Prevention and Control

Pre-existing ProvincialSentinels

ProvincialTerritorial

Health Depts.

Providers& Users

National MicrobiologyLaboratory

P/T SentinelLaboratories

RECRUITS, COLLECTS

RECEIVES USES

COLLATES ANALYSES

INTERPRETS DISSEMINATES

COLLECTS

LEGEND:

FluWatch/NaReSSentinels

Flow of Information

Function

FluWatch Partner/users

Provided by Jeannette Macey 2002

NaReS FluWatch NaReS FluWatch Recruitment ProceduresRecruitment Procedures

Welcome packages faxed out in September Extra sentinels recruited (faxing

recruitment packages / phone calling) in CDs as

needed using expected rate of 1 sentinel per 250,000 population

Recruitment process labour intensive in fall but now continues year round for new and replacement recruits

Sample Fluwatch Reporting FormSee additional handout

\\cfpcfile\cfpc\research\Anita\reporting form.pdf

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Reporting week code

Series1 76. 80. 75. 82.182. 82. 83. 84. 85. 90. 82. 83. 66. 62. 83. 83. 81.2 82. 81.982. 82.179. 80.184.177. 75. 77.173. 78. 80.167.159.174. 76. 72. 77. 79. 76. 67. 65. 72. 72. 63. 63. 65. 65. 57.

40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

Weekly Sentinel Participation Rates (Oct 03-Aug 04) (average=78.9% between Oct-May)

April blip?

holidays

0

20

40

60

80

100

120

140

160

Total Reporting vs Total Responding Sentinels (Oct 4, 2003 wk 41 - Aug 21, 2004 wk 35)

TOTAL REPORTING SENTINELS TOTAL RESPONDING

Participation Rates by Province 2003-04 Participation Rates by Province 2003-04 # of

CDs/HRs# CDs/HRsfilled

% CDs / HRs filled by season end

Peak # of sentinels

# sentinels as of apr 2004

Manitoba 12 9 75% 18 15

Ontario 49 38 78% 71 69

Quebec 19 7 37% 17 16

New Brunswick 7 6 85% 17 17

Nova Scotia 18 14 78% 17 17

NewFoundland / Labrador

10 5 50% 7 7

PEI 3 2 66% 3 3

TERR 6 3 50% 15 14

TOTALs 124 84 67% 165 158

Data Collection ProcessData Collection ProcessEvaluation SurveysEvaluation Surveys

NaReS FluWatch Sentinels (n=158) were

sent an Evaluation Questionnaire in Mar 2004 7 requested discontinuation throughout year French speaking sentinels received evaluation

form in French if indicated Response Rates to Evaluation=138/158 (87%)

Evaluation of Participation

#n=13

8%

Agree

Amt of time spent completing Forms was < 15 minutes

105 76.1

Amt of time required for participation was acceptable

136 98.6

Instructions clear & easy to follow

138 100.0

Weekly reporting forms easy to complete

136 98.6

Recv’d weekly forms on timely basis

132 95.7

Evaluation of Participation

#n=138

%Agree

Faxing reports did not present any problems

132 95.7 

Amt of detail requested was acceptable

136 98.6

Frequency of ILI (weekly) was acceptable

132 95.7

Interested in participating for other conditions on an ad hoc

100 72.5

Received FluWatch reports each week

frequencypercen

t

Yes80 58.0

NoNo answer

57 1

41.30.7

Total138 100.0

Case definition of Influenza appropriate # %

Yes 137

99.3

No 1 .7

Total 138

100.0

Comments:

o In a walk-in setting, I had lots of ILI by definition, which I knew to be other dx- pneumonia, strep, which I would label as such.

o Difficulty with concurrent illness or unusual strains.

o The definition was appropriate. However, for clarification purposes I would like to see the work “with” underlined or bolded. We had some discussion over this.

Did you take any clinical samples for influenza culture testing of ILI patients # %

Yes 50 36.2

No 88 63.8

Total 138 100.0

Taking clinical samplesTaking clinical samples41

21

15

(n=50 sentinels)

Beginning of Flu season Middle of Flu season End of Flu season

#

40

11

5

0

5

10

15

20

25

30

35

40

clinical sample

naso-pharyngeal swab throat swab throat gargles

#

Type of Clinical Samples Taken

(n=50 sentinels with more than one choice in some cases)

Has participated year round (self-report)76/13

8 55.1%

Not willing to participate year-round but during regular FluWatch season only

50/138

36.2%

Not returning 3/138 2.2%

Unsure about returning 3/138 2.2%

Did not answer 6/138 4.3%

Total 138 100/0%

Applied for CME MainPro 2 credits for FW # %

Yes43

31.2

No95

68.8

Total138

100.0

Practice Profile of Practice Profile of SentinelsSentinels

Does your practice focus on any particular group? # %

Yes*Yes* 77 5.15.1

No 130 94.2

No answer 1 .7

Total138

100.0

*N.B. 4 mainly female patients, 1 in emergency, 1 focused on seniors

Geographic location of practice # %

Urban/surburban 39 28.3

Inner City 5 3.6

Small Town 42 30.4

Rural 44 31.9

Geographic isolated 8 5.8

Total 138 100.0

Practice Profile of Practice Profile of SentinelsSentinels

Practice Profile of Practice Profile of SentinelsSentinels

Overall age of your practice population # %

no age predominates 44 31.9

40-64 51 36.9

>65 31 22.5

<40 12 8.7

Total 138 100.0

Main Practice Setting # %

Private Practice 98 71.0

Community Clinic / CHC 21 15.2

Academic FM teaching unit 11 8.1

Emergency Department 4 2.9

Free standing walk-in clinic, nursing home or remote nursing station

3 ,2.1

Did not answer 1 .7

Total 138 100

Patient Visits among sentinelsPatient Visits among sentinels (n=138)(n=138)

0102030405060708090

pre-scheduled appts walk-in ER

#

81/138 (58.7%) report up to 20%Of their patient visits are walk-ins

Conclusions / Recommendations

spring of 2004 Health Canada decided to continue faxing reporting forms weekly for summer months

large drop in sentinels agreeing to participate over the summer months was expected & did occur but not to the level of previous summers

done on assumption that asking would underscore need for regularization of year-round surveillance

year-round surveillance among NaRes Sentinels continues to rise to a limited extent (55%) in 2004

36.2% of 2003-04 surveyed sentinels still prefer to report ONLY during the regular season

SARS and Avian virus threats may have heightened sentinel commitment necessary for year round reporting but additional CME promotion and effort is still required

Toronto 2004 FMF Toronto 2004 FMF Influenza WorkshopInfluenza Workshop

Attendees committed but concerned re:– Need for expansion – Lack of time – Compensation for

surveillance work in primary care

– Need for combining clinical & research updates in 1 CME session

Researchers would like _ to find an RFP to support

the testing/analysis of networked surveillance data from GP/FP practices

_ Link surveillance to E-data capture methods to provide more timely feedback to sentinel physicians re: their own collective lab reports etc.

Attendees surveyed at the FMF workshop in Toronto confirmed that

being a FluWatch sentinel kept them in the influenza information loop.

They are concerned about new and emerging diseases as demonstrated by a comment from Dr. Peter McKean (PEI

sentinel) “I feel that it (sentinel surveillance) is of essential importance to public health.” This concern was underscored by the

fact that greater than half of the participants at the workshop do

surveillance year round.