Practices around acute diarrheal illness diagnosis, counseling, and reporting: Laboratory and health-care practitioners in North Carolina, 2004

Objectives: To describe foodborne disease surveillance in North Carolina, particularly diagnosis, counseling, and reporting of diagnoses from health-care practitioners (HCPs) and reporting of positive laboratory results from clinical diagnostic laboratories. Materials: A survey was administered on knowledge of diagnostic testing and reporting practices for foodborne disease among HCPs in western North Carolina. We also queried laboratories statewide about foodborne disease testing and reporting practices. Results: HCPs in specialties likely to diagnose acute diarrheal illness (ADI) participated (319/1442, 22% response rate). Only 66% of HCPs were comfortable with their knowledge of foodborne illness, and 68% were comfortable diagnosing and treating foodborne illnesses. In the past 30 days, 29% of HCPs did not request a stool culture from their ADI patients. We estimate that, overall, 8% of ADI patients who sought care in this region have a diagnosis that is reported to the health department (HD). The laboratory response rate was 39% (42/108), and 70% gave timely foodborne diagnosis reports to the HD. In this cross-sectional study, causes of reporting behavior could not be explored. In. addition, HCPs survey response rates were low. Conclusions: Many HCPs were not comfortable with their knowledge and did not adequately provide counseling on prevention of foodborne illnesses. HCPs in western North Carolina may benefit from provider training on foodborne illness counseling and reporting. Improvements in communication between laboratories, HCPs, and HDs may increase HCP confidence in diagnosing foodborne illnesses and increase counseling of patients on prevention. Increased requests for testing of stool specimens by HCPs could substantially impact foodborne disease reporting in North Carolina.