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RESEARCH LETTERS

Zoonotic diseases and at-risk patients: a survey of veterinarians and physicians

von Matthiessen, Pamela W; Sansone, Randy A; Meier, Brian P; Gaither, George A; Shrader, John

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Using a self-report questionnaire, this study was designed to determine the involvement of physicians and veterinarians in providing information to immune-compromised patients on the risks of zoonotic disease. Results indicate that, compared with physicians, veterinarians report discussing zoonotic diseases with clients more often, as well as gathering and providing information to their clients in a greater number of ways. These data suggest that zoonotic risks to immune-compromised patients may be under-attended by physicians.

Zoonoses (i.e. diseases transmittable from animals to humans) can present a health risk to pet owners, particularly those who are immune compromised [1–4]. Given the prevalence of pet ownership, in which close contact might increase the risk of zoonotic infection, and the prevalence of immune-compromised patients, we conducted a survey of veterinarians and physicians to explore these issues.

Veterinarian candidates were solicited from the Miami Valley chapter of the American Veterinarians Medical Association (n = 150). Physician candidates were solicited from the Montgomery County Medical Society (n = 300) and consisted of primary care physicians (i.e. internal medicine, family practice, pediatrics) and internal medicine specialists. The study sample consisted of 84 veterinarians (49 men, 34 women, one not reporting) and 118 physicians (76 men, 29 women, 13 not reporting), resulting in a response rate of 56% for veterinarians and 39% for physicians. The mean age for veterinarians was 44.12 years (SD 12.27), and the mean number of years in practice was 17.88 years (SD 12.74). The mean age for physicians was 46.15 years (SD 0.27), and the mean number of years in practice was 15.51 years (SD 10.33).

Each study candidate was mailed a one-page survey, and a stamped and addressed return envelope. The survey introduction identified researchers, clarified the purpose of the study, indicated assumed consent for participation through completion of the survey, and affirmed the confidentiality of responses. The survey content explored demographic variables (age, sex, years in practice); the number of immune-compromised patients seen in the office per week (physicians only); the frequency of the discussion of zoonotic risks (for physicians, with immune-compromised patients; for veterinarians, with pet owners, who may or may not have been immune compromised); whether there were any educational brochures in the office setting related to pet zoonoses; and whether the professional had ever explored a website to obtain information about zoonotic risks. We also asked respondents whether they had ever contacted, or been contacted by, their counterpart regarding zoonotic diseases for patient or client-related concerns or information sharing, whether the respondent had ever accessed their counterpart to discuss risks of pet ownership, and which professional (or both) should advise at-risk clients or patients about zoonotic disease. The Institutional Review Board of the hospital approved the study.

Table 1 presents the numbers and frequencies reported for first five survey items by type of professional, as well as χ2 values for between-group tests. For the last two items in the table only ‘Yes’ responses were analysed. For most items, the patterns were positively skewed to veterinarians. Through a series of Pearson product moment correlations, run separately for veterinarians and physicians, results revealed that neither age nor the number of years in practice were significantly related to the number of ways of obtaining or providing information, as these four correlations ranged from r = 0.03 to r = 0.11, with none being statistically significant.

Table 1
Table 1:
Patterns of discussing zoonotic risks with clients (veterinarians) or immune-compromised patients (physicians).

The majority of veterinarians and physicians were most likely never to have contacted a counterpart (78.6 and 89.0%, respectively), χ22 = 6.19 (3, n = 202), P = 0.10. Physicians were significantly more likely to report having never been contacted by a counterpart (100 versus 78.6%), χ2 = 27.76 (3, n = 202), P < 0.001.

Regarding which professional they believed should be responsible for discussing zoonotic diseases with at-risk clients/patients, veterinarians were significantly more likely to report believing that both professionals were responsible (82.2 versus 96.4%, respectively), χ2 = 9.58 (3, n = 202), P < 0.01. It should be noted, however, that this was the most frequent response for both groups.

To summarize, compared with physicians and their patients, veterinarians appear more likely to discuss zoonotic diseases and the risks of pet ownership with clients and more likely to gather and provide information to clients on zoonotic diseases. Although the majority of both professional groups believe that the risk of zoonotic disease is a shared responsibility, there appears to be minimal interaction between physicians and veterinarians with regard to such matters.

If these conclusions are valid, there may be a variety of explanations. First, veterinarians may be more keenly aware of such risks because of their ongoing contact with animals. Second, it may be that physicians become preoccupied with managing the complexities of the disease process itself (e.g. HIV), and prioritize patient queries and education in other areas (e.g. medication regimens, diet, sexual behaviors). Third, physicians may not be aware that there is a pet at home.

Although these data indicate that there is limited communication of zoonotic issues between the two professional groups, these professionals are not genuinely sharing a ‘patient’. Physicians interact with patients and veterinarians interact with pet owners (i.e. the pet is the patient). This phenomenon, in addition to geographical and professional isolation, may compromise communication and promote professional isolation. For these preceding reasons, communication formats are probably not well established.

The potential limitations of this study include the response rate, a lack of the reported number of clients seen each week by veterinarians to enable group comparisons, and the self-report nature of data. However, these data suggest that the issue of zoonotic disease and its potential effects on patients may be under-attended to by physicians. Confirmation of this impression requires further research. Hopefully, these data will highlight the issue, and stimulate the development and use of information resources in this important area of patient care.

References

1. Glaser CA, Angulo FJ, Rooney JA. Animal-associated opportunistic infections among persons infected with the human immunodeficiency virus.Clin Infect Dis 1994, 18:14–24.
2. Glaser C, Lewis P, Wong S. Pet, animal and vector-borne infections.Pediatr Rev 2000, 21:219–232.
3. Gorbach SL, Bartlett JG, Blacklow NR. Zoonotic diseases in immunocompromised patients. In: Infectious diseases, 2nd ed. Philadelphia: WB Saunders; 1998. pp. 1542–1545.
4. Tan HS. Human zoonotic infections transmitted by dogs and cats.Arch Int Med 1997, 157:1933–1943.
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