In 2007-08, the Centers for Disease Control and Prevention (CDC) Dengue Branch and the Puerto Rico Department of Health (PRDH) conducted a survey to assess physician’s knowledge of dengue and clinical management practices.
The survey identified limited knowledge of warning signs for severe dengue and early signs of shock and non-standard treatment practices including use of corticosteroids and non-isotonic crystalloid solutions. A review of fatal dengue cases in 2007 corroborated these findings.
In 2008-09, CDC Dengue Branch developed and pilot tested a physician training course to address the deficiencies identified by the survey and fatal case review. Focus groups and interviews were conducted with attendees of the pilot course to evaluate instructional process and content, and the course was revised accordingly.
The course was approved by CDC and accredited by the Accreditation Council for Continuing Medical Education for 4 CME credits in February 2009. The Secretary of Health of Puerto Rico mandated that physicians take the training as a prerequisite for re-certification by 2013. To fully implement the case management course, 52 physicians were selected, trained and certified as Master Trainers. From February 21, 2009 to December 31, 2010, 55 courses attended by 8,301 of the 12,929 licensed physicians in Puerto Rico were conducted. Most physicians (6,294, 76%) were trained between September 1 and October 31, 2010 in response to another mandate from the Secretary of Health that all primary care physicians be trained immediately due to the increased number of dengue fatalities. An evaluation of the impact of training on clinical practices will be conducted in the Fall of 2011. Findings from this evaluation will be used to redirect continuing training efforts and to develop an online dengue clinical management course. Lessons learned from the implementation of this training initiative will be shared with dengue endemic countries planning to train physicians on the clinical management of dengue.
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