San Luis Obispo County, commonly known as SLO, is picturesque mix of urban and rural communities located on the central coast of California. With a total population of 277,977, nearly 25% of those are over the age of 60, a relatively higher share of the population as compared to the state average of 18% senior citizens. Most residents identify as white (69%), followed by Hispanic/Latino (22%). Key industries in the county include tourism, education, energy, agriculture and government. The county includes seven cities, though most of the county's 3,326 square miles are unincorporated. The eastern region is sparsely populated with vast areas of agricultural and undeveloped government lands between small, unincorporated towns.
Clinicians everywhere have faced the challenge of rapidly differentiating infectious respiratory diseases to provide the most direct path to treatment for each patient, but also to protect members of the community from infectious disease. Respiratory diseases, however, often present in a way that defies ready differentiation. With additional testing and information now available, we have learned that a better understanding of regional epidemiology of illnesses can help inform diagnosis of respiratory disease. We developed this new resource for clinicians, the Respiratory Disease DIfferentiation Quick Reference Poster, that incorporates local information to help differentiate among influenza, community-acquired pneumonia, coccidioidomycosis (Valley fever), and tuberculosis (TB).
In SLO County, we see distinct trends and challenges in accurately diagnosing these illnesses. TB, for example, is quite uncommon in SLO County, with an incidence rate of 2.2 per 100,000 (well below the state average of 5.2). Yet we frequently see TB on the differential diagnosis for patients who present with respiratory symptoms. This creates the need for isolation, thereby adding a burden to the patient and to our health care system—a burden we should ask them to carry only when truly needed.
Valley fever, on the other hand, is relatively common in SLO County with an incidence rate of 150.4 per 100,000 (compared to the state average of 18.8). This fungal infection is highly endemic in southern Arizona and California's southern San Joaquin Valley, as well as SLO County. Yet Valley fever is often not suspected until other possibilities have been eliminated. For patients, that can mean unnecessary antibiotics, uncomfortable tests, and months of anxiety as symptoms worsen. Often misdiagnosed as bacterial pneumonia, the CDC estimates about 60 80% of patients with Valley fever are given one or more rounds of antibiotics before receiving a correct diagnosis and appropriate treatment.
The goal of this practice was to support local clinicians in respiratory disease differentiation. Our plan to achieve this was to provide clinicians with information about the regional epidemiology of influenza, community-acquired pneumonia, Valley fever, and TB for consideration when assessing patients presenting with symptoms of respiratory illness.
The goal and objectives were achieved based on the positive feedback we received and the continued interest in the poster. We are also pleased that our development of this poster is helping other jurisdictions. Since other local health departments expressed interest in using the poster to support their local clinicians, we created a customizable template of the poster for health departments to insert their local epidemiology information and department branding.
The primary factor that led to the success of the practice was the recognition that an understanding of local epidemiology can be essential in ensuring accurate and timely diagnosis and treatment of respiratory diseases. In addition, we listened to our target audience to learn how to best package and present this information.
Due to age-related characteristics like frailty and immunosenescence, respiratory infections produce more severe illness, a larger number of hospitalizations, and greater mortality in older than in younger adults. With one quarter of the SLO County population over the age of 60, and an aging population nationwide, public health can provide clinicians with the epidemiological information they need to support accurate and timely diagnosis and treatment of respiratory diseases.
Please view the Respiratory Disease Differentiation Quick Reference Poster at file:///P:/Admin/NACCHO%20MP%20Award%20App/Respiratory_Disease_Quick_Reference_SLOCo_2019.pdf and visit the County of San Luis Obispo Public Health Department website at:https://www.slocounty.ca.gov/Departments/Health-Agency/Public-Health.aspx