Promoting Early Recognition and Management of Valley Fever in Primary Care Settings

Abstract

PURPOSE. This project was designed to strengthen primary care provider (PCP) knowledge and confidence in Valley fever diagnosis, treatment, and specialty-referral requirements at a Southern Arizona rural community health organization.BACKGROUND. Coccidioidomycosis (i.e., Valley fever) is a fungal infection acquired by inhaling spores located in the dust of endemic regions. Southern Arizona has the highest incidence of the disease in the nation, with Maricopa, Pima, and Pinal Counties accounting for over half of all cases in the United States. Despite the fact that Valley fever is responsible for one-third of all pneumonia cases diagnosed in Southern Arizona, only 13% of Arizona PCPs appropriately test for the disease. Patients experience on average a one-month delay for diagnosis, and more than 80% of cases are initially misdiagnosed. This delay to diagnosis leads to increased healthcare costs, increased incidence of complications, and delayed specialist referral for high-risk patients. METHODS. The multilevel intervention design included a 30-minute, synchronous provider education session delivered via Microsoft TEAMS. Education content was developed from Infectious Disease Society of America (IDSA) clinical practice guidelines, a 2017 CDC Valley Fever PCP training video, and the Valley Fever Center for Excellence (VFCE) training manual for PCPs. A pocket-sized handbook and printable flowchart of the educational material was also provided. Evaluation was accomplished with a post-pre survey examining provider knowledge, attitudes, and practices related to Valley fever diagnosis and management. A “Valley Fever Champion” was selected from among participating PCPs to provide quarterly educational emails and attend the annual VFCE meeting. RESULTS. Of the 31 providers in attendance, 19 completed the post-education evaluation survey. Statistically significant improvements were seen in provider confidence in ability to diagnose (p=.001) and treat (p=.011) Valley fever, and knowledge of lab testing options (p=.031). Modest improvements were gained in knowledge of vaccine availability and health department notification requirements. Notably, among providers who obtained their clinical degree in Arizona, only 20% reported receiving prior education on Valley fever. CONCLUSIONS. This project demonstrates an effective model for providing Valley fever training to Arizona PCPs and connecting them with local specialists and resources from organizations such as the VFCE.