The confidential survey was mailed to a national sample of 976 physicians randomly selected from the computerized database of approximately 53,900 active members of the AAFP. Approximately 85% of active members spend at least 70% of their professional time in direct patient care. Two subsequent mailings were sent to non-respondents. The initial survey was mailed in October 2001, before the first case of anthrax was reported to the Centers for Disease Control and Prevention.1
Three survey items were the main outcomes of the study because they represented the key features of family physician preparedness: (1) “knowing what to do as a doctor in the event of a suspected bioterrorist attack in my community,” (2) “recognizing signs and symptoms of an illness due to bioterrorism in my own patients,” and (3) “knowing where to call to report a suspected bioterrorist attack.” For analysis, Likert scale responses of “strongly agree” and “agree” were collapsed into a single category because of the small number of “strongly agree” responses. Similarly, “strongly disagree” and “disagree” responses were combined. Student’s t-test and Pearson’s chi-square test were used to assess statistical significance in bivariate analyses. Multivariate logistic regression was performed to assess the effects of age, sex, geographic location, risk assessment, ability to gather information, and previous training in bioterrorism preparedness on the main outcomes of interest. These variables were selected a priori from the conceptual model of the survey. Analyses were conducted using STATA, v. 7.0 (Stata Corp., College Station, TX).
Results
Of the 976 family physicians sent the bioterrorism survey, 614 (63%) responded. The average age of the respondents was 45 years (range 28–76 years) and 70% were male. Respondents were distributed among rural, suburban, and urban geographic locations (Table 1). Respondents did not differ significantly from non-respondents with respect to age, gender, medical training, or board certification (Table 1).
Although 95% of physicians agreed that a bioterrorist attack is a real threat within the United States, only 27% believed the United States health care system could respond effectively to such an attack (Table 2). Thirty-nine percent believed that an attack is a real threat in their local communities; however, only 19% thought their local medical community could respond effectively. Sixty percent thought it likely that current public health surveillance systems could quickly identify a bioterrorist attack. Physicians’ thoughts about the biochemical agents most likely to be used in an attack are listed in Table 3.
Almost three quarters of physicians did not feel prepared to respond to a bioterrorist attack. Only 24% of those surveyed believed they could recognize signs and symptoms of an illness in their patients due to bioterrorism, and 38% rated their current knowledge of the diagnosis and management of bioterrorism-related illness as poor. Moreover, only 18% of physicians had received previous training in bioterrorism preparedness (Table 2).
When asked about their ability to deal with natural disasters or infectious disease outbreaks, a significantly higher percentage of physicians reported they would know how to respond to these major public health events (Table 2). Twenty-six percent of physicians reported they would know what to do in the event of a bioterrorist attack, compared with 65% (P <0.001) of physicians who reported they would know what to do in the event of a natural disaster and 66% (P <0.001) who reported knowing what to do in an infectious disease outbreak. After combining responses for local hospitals and community preparedness, only 17% believed that both their hospitals and their medical communities could respond effectively to a bioterrorism attack, compared with 60% (P <0.001) for a natural disaster and 56% (P <0.001) for an infectious disease outbreak. Physicians who felt prepared for natural disasters were 4 times more likely than other doctors to know how to respond to a bioterrorist attack (36% vs. 9%, P <0.001). Physicians who felt prepared for infectious disease outbreaks were 6 times more likely than other doctors to know how to respond to a bioterrorist attack (37% vs. 6%, P <0.001).
Importantly, physicians felt better prepared for a bioterrorist attack if they had training in bioterrorism preparedness. Physicians who had received such training were 3 times more likely than other doctors to know how to respond to a bioterrorist attack (55% vs. 20%, P <0.001). Ninety-eight percent thought it was important for them to be trained to identify a bioterrorist attack, and 93% of physicians said they would like such training.
Familiarity with the public health system was not necessarily associated with physicians’ preparedness for bioterrorism. While 93% of physicians report notifiable infectious disease cases to the health department, only 57% (P <0.001) reported knowing whom to call to report a suspected bioterrorist attack. Fifty-six percent of physicians reported knowing how to get information if they suspected an attack in their community.