Ebola Risk and Preparedness: A National Survey of Internists.
BACKGROUND
The 2014-2015 Ebola virus disease (Ebola) epidemic centered in West Africa highlighted recurring challenges in the United States regarding risk communication and preparedness during global epidemics.


OBJECTIVE
To investigate perceptions, preparedness, and knowledge among U.S. internists with regard to Ebola risk.


METHODS
Cross-sectional Web-based national survey distributed by e-mail between December 2014 and January 2015.


METHODS
Practicing U.S. internists participating in a research panel representative of American College of Physicians (ACP) membership.


METHODS
Respondents' perceptions of Ebola, reported sources of information, and reported management of possible Ebola cases. The primary predictor was the possibility of encountering Ebola (based on respondents' geographic proximity to designated airports or confirmed Ebola cases, or on their patients' travel histories). Pre-specified outcomes included reported management intensity in clinical vignettes involving patients at low risk of symptomatic Ebola as well as reported Ebola preparedness.


RESULTS
The survey response rate was 46.1 %. Among the 202 respondents, 9.9 % (95 % CI 6.2-14.9 %) reported that they had recently evaluated a patient who had traveled to West Africa. Seventy percent (95 % CI 63.0-76.0 %) reported a practice-level protocol. The Centers for Disease Control and Prevention (CDC) was the most popular source for Ebola information (75.2 %, 95 % CI 68.7-81.0 %). Most respondents felt very (45.0 %) or somewhat prepared (52.0 %) to communicate information about or diagnose Ebola, especially those with the possibility of encountering Ebola and those who reported medical journals, professional groups, or government as information sources. One-fifth of respondents (19.8 %, 95 % CI 14.5-26.0 %) reported overly intensive management for low-risk patients. Those with the possibility of encountering Ebola were less likely to report overly intensive management (3.1 vs. 22.9 %, p = 0.011).


CONCLUSIONS
Internists had wide-ranging views and understanding of Ebola risk; those least likely to encounter Ebola were most likely to be overly aggressive in managing patients at low risk. Our findings underscore the need for better risk communication through various information channels to empower frontline providers in infectious disease outbreaks.
Massachusetts General Hospital, 55 Fruit Street Bulfinch 205, Boston, MA, 02114, USA. iganguli@partners.org.|Harvard Medical School, Boston, MA, USA. iganguli@partners.org.
Ishani
I
Ganguli
Massachusetts General Hospital, 55 Fruit Street Bulfinch 205, Boston, MA, 02114, USA.|Harvard Medical School, Boston, MA, USA.
Yuchiao
Y
Chang
American College of Physicians, Philadelphia, PA, USA.
Arlene
A
Weissman
Massachusetts General Hospital, 55 Fruit Street Bulfinch 205, Boston, MA, 02114, USA.|Harvard Medical School, Boston, MA, USA.
Katrina
K
Armstrong
Massachusetts General Hospital, 55 Fruit Street Bulfinch 205, Boston, MA, 02114, USA.|Harvard Medical School, Boston, MA, USA.
Joshua P
JP
Metlay
D000328:Adult; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
Ebola; evidence based medicine; medical decision making; physician behavior; risk communication