BACKGROUND Rabies is endemic in southern Bhutan, associated with 1-2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians' management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023. METHODS A cross-sectional survey of 50 clinicians' management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February-March 2016. RESULTS Data were collected on clinicians' management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years' experience. There was poor agreement between clinicians' rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals. CONCLUSIONS This study highlights important discrepancies between clinicians' management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician's management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians' practices.

中文翻译：

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对暴露后预防措施的评估，以提高在不丹南部可能暴露于狂犬病的人类病例中狂犬病控制的成本效益。

背景技术狂犬病是不丹南部的地方病，每年造成1-2人死亡和高暴露后预防（PEP）费用。评价临床医生对可能暴露于狂犬病的人类病例的管理，可能有助于改善PEP处方操作，既减少与PEP相关的不必要费用，又可以在2023年前达到零的狂犬病死亡人数目标。方法对50名临床医生进行的横断面调查在2016年2月至3月期间，在不丹高狂犬病高风险地区的13个卫生中心进行了对可能暴露于狂犬病的人类病例的管理。结果收集了临床医生对273例可能暴露于狂犬病的人类病例的管理数据。这50名临床医生包括健康助理或临床官员（55％）和医生（45％），其中位数分别为19，21和2年的经验。与根据《国家狂犬病管理指南》（NRMG）的标准对每个病例​​进行的独立评估相比，临床医生的狂犬病风险评估之间的一致性差。在194名临床医生记录了狂犬病风险类别的病例中，与NRMG相比，只有53％被正确分类。临床医生更容易低估狂犬病暴露的风险，并且似乎独立于他们的风险分类开出PEP处方。男性健康助手进行的风险评估最准确，女性健康助手进行的准确性最低。与医院相比，基本卫生部门的临床医生进行的风险评估较不准确。结论本研究强调了临床医生之间的重要差异。NRMG中可能暴露于狂犬病的人类病例的管理和建议。特别是，临床医生没有准确评估潜在暴露病例中的狂犬病风险，也没有基于他们的风险评估来进行PEP治疗。这对于实现到2030年消除狗介导的人类狂犬病的国家目标具有重大意义，并且可能导致与PEP相关的不必要的费用。改善临床医生对可能暴露于狂犬病的人类病例的管理的建议包括：审查和更新NRMG，为临床医生提供有关狂犬病风险评估和PEP处方的定期且适当针对性的培训，并定期审查临床医生的做法。临床医生没有准确评估潜在暴露病例中的狂犬病风险，也没有基于他们的风险评估来进行他们的PEP治疗。这对于实现到2030年消除狗介导的人类狂犬病的国家目标具有重大意义，并且可能导致与PEP相关的不必要的费用。改善临床医生对可能暴露于狂犬病的人类病例的管理的建议包括：审查和更新NRMG，为临床医生提供有关狂犬病风险评估和PEP处方的定期且适当针对性的培训，并定期审查临床医生的做法。临床医生没有准确评估潜在暴露病例中的狂犬病风险，也没有基于他们的风险评估来进行他们的PEP治疗。这对于实现到2030年消除狗介导的人类狂犬病的国家目标具有重要意义，并且可能导致与PEP相关的不必要的费用。改善临床医生对可能暴露于狂犬病的人类病例的管理的建议包括：审查和更新NRMG，为临床医生提供有关狂犬病风险评估和PEP处方的定期且适当针对性的培训，并定期审查临床医生的做法。这对于实现到2030年消除狗介导的人类狂犬病的国家目标具有重大意义，并且可能导致与PEP相关的不必要的费用。改善临床医生对可能暴露于狂犬病的人类病例的管理的建议包括：审查和更新NRMG，为临床医生提供有关狂犬病风险评估和PEP处方的定期且适当针对性的培训，并定期审查临床医生的做法。这对于实现到2030年消除狗介导的人类狂犬病的国家目标具有重要意义，并且可能导致与PEP相关的不必要的费用。改善临床医生对可能暴露于狂犬病的人类病例的管理的建议包括：审查和更新NRMG，为临床医生提供有关狂犬病风险评估和PEP处方的定期且适当针对性的培训，并定期审查临床医生的做法。