Compliance with RSV prophylaxis: Global physicians’ perspectives

Figures & data

Table 1 Survey questions

Number	Question	Answers/Options
1	Please select the country in which you currently practice.	Drop-down list
2	Please select your specialty:	– Pediatrics – GP – Family medicine – Internal medicine – Combined internal medicine/Pediatrics – Surgery – Other, please specify
3	Please select your subspecialty:	– Neonatology – Pediatrics – Pulmonology – Cardiology – Infectious disease – Neurology – Immunology/Allergy – Intensive care – Other, please specify
4	How many years have you been a practicing physician?	– <5 – 5–10 – 11–20 – 21–30 – 31–40 – >41
5	Please indicate your type of practice (Select all that apply):	– Academic – Private – Government – Other, please specify
6	What are the main sources of continuing education in your country? Please select all that apply.	– University – Journals – Medical representatives – Medical or scientific memberships – Attendance at congresses or conferences – Other, please specify
7	Please indicate the level of your patients’ parents/caregivers education (in percent with total equaling 100%. If not known, please leave blank):	– Highly educated (university) – Some education (primary and secondary) – No formal education
8	How do your patients pay you? Select all that apply.	– Self-pay – Government sponsored – Private insurance – Other, please specify
9	What percent of your patient population is born: – <35 weeks gestational age? – With hemodynamically significant congenital heart disease?	Respondent fill-in
The following four (4) questions will refer to specific patient types. For simplification purposes, they will be coded as shown below: <29 wGA, no BPD: <29 weeks gestational age without bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD) 29–32 wGA, no BPD: 29–32 weeks gestational age without BPD/CLD 33–35 wGA, no BPD: 33–35 weeks gestational age without BPD/CLD BPD/CLD: diagnosed with BPD/CLD CHD: diagnosed with congenital heart disease (CHD)
10	Which of the following patient types do you see/treat in your practice? Select all that apply	– <29 wGA, no BPD – 29–32 wGA, no BPD – 33–35 wGA, no BPD – BPD/CLD – CHD – None of the above
11	Please indicate your satisfaction with the literature supporting the use of palivizumab/Synagis^® in the following high-risk groups. – <29 wGA, no BPD: – 29–32 wGA, no BPD: – 33–35 wGA, no BPD: – BPD/CLD: – CHD:	Respondent fill-in using 1–5 scale (1 = extremely satisfied 5= extremely dissatisfied)
12	In what percent of patients do you recommend palivizumab/Synagis^® prophylaxis: – <29 wGA, no BPD: – 29–32 wGA, no BPD: – 33–35 wGA, no BPD: – BPD/CLD: – CHD:	Respondent fill-in
Palivizumab/Synagis^® is indicated for the prevention of serious lower respiratory tract disease requiring hospitalization caused by respiratory syncytial virus (RSV) in children at high risk for RSV disease: Children born at 35 weeks of gestation or less and less than six months of age at the onset of the RSV season Children aged less than two years and requiring treatment for bronchopulmonary dysplasia within the last six months Children aged less than two years and with hemodynamically significant congenital heart disease
13	Have you ever NOT recommended palivizumab for a patient who met indications in the following patient groups? – <29 wGA, no BPD – 29–32 wGA, no BPD – 33–35 wGA, no BPD – BPD/CLD – CHD – Other, please specify	Yes/No
14	Please select the top three (3) reasons why you would NOT recommend palivizumab/Synagis^® for your indicated patients.	– Lack of reimbursement – Lack of data to support use – Safety – Cost of palivizumab – Inconvenience for the patient/family – Inconvenience for the medical staff/nursing staff – Other, please specify
15	Are parents/caregivers of patients provided with information on the risks of severe RSV and palivizumab prophylaxis?	Yes/No
16	Please indicate in which format the information is provided. Select all that apply.	– Written (text only) – Pictures/diagrams (visuals with text) – Verbal – Other, please specify
17	Who is primarily responsible for providing the information to the patient’s parent/caregiver?	– MD – Resident or fellow – Nurse – Office – Other, please specify
18	Is written information provided in the parent/caregiver’s native language?	Yes/No
19	For those who are not fluent in the local language, is an interpreter used?	Yes/No
20	Are parents/caregivers requested to repeat the information provided to them in order to validate the teaching message?	Yes/No
21	When is RSV generally first discussed with your patients’ parents/caregivers?	– Prior to primary hospital discharge (ie, birth hospitalization) – After primary hospital discharge – During hospital re-admission – Never – Other, please specify
22	In patient populations where the parent/caregiver refuses initiation of prophylaxis, what do you believe are the top three (3) factors that contribute to a parent/caregiver’s refusal?	– Inconvenience – Cost – Perceived lack of benefit from palivizumab/Synagis^® – Incomplete knowledge of the threat from RSV – Palivizumab/Synagis^® perceived as unsafe – Parent/caregiver’s belief that RSV exposure can be limited – Personal “antivaccine” beliefs – Cultural beliefs – Religious beliefs – Other, please specify
23	What do you believe are the top three (3) factors that contribute most to noncompliance with palivizumab/Synagis^® recommendations? (Noncompliance is defined as infants who have therapy initiated, but do not receive all recommended doses.)	– Inconvenience to parents/caregivers – Distance to clinic – Parent/caregiver time off work – Cost of product – Issues related to other children – Fear of injections – Lack of availability of palivizumab – Lack of perceived benefit of palivizumab by the parent/caregiver – Perception by parent/caregiver that the product is unsafe – Adverse reactions from palivizumab – Adverse reactions from other medications or vaccines – Lack of understanding regarding threat of RSV – Other, please specify
24	What do you believe are the top three (3) factors that contribute most to full compliance with palivizumab/Synagis^® recommendations? (Full compliance is defined as patients receiving all recommended doses.)	– Educational materials regarding threat of RSV – RSV illness in a previous child – Recommendations from physician for palivizumab – Administration of palivizumab in a previous child – Coordination of palivizumab doses with other medical or vaccination visits – Prearranged transportation to palivizumab administration visits – Participation in parent or advocacy groups – Reminders of the palivizumab administration visit from the hospital or clinic – Administration of palivizumab in home – Home educational and hospital follow-up visits from nurses – Home educational and hospital follow-up visits from physicians – Other, please specify
25	In order to increase compliance, what are the top three (3) interventions you would recommend?	– Additional educational materials – Satellite clinics – Frequent reminders from the hospital – Addition of home visits – Home administration of palivizumab prophylaxis – Education of patient’s family – Reimbursement – Transportation to the palivizumab dosing visits – Other, please specify
26	Considering your country’s routine immunization schedule, what % of children in your practice receive all recommended doses of immunizations?	– 0%–25% – 26%–50% – 51%–75% – 76%–100% – My country does not have a routine immunization schedule
27	Do you view palivizumab/Synagis^® as an equivalent to a vaccine?	Yes/No
28	In your opinion, is palivizumab considered by the parents/caregivers of your patients to be equivalent to a vaccine?	Yes/No
29	If you do NOT intend to recommend palivizumab to a patient who meets the indications for prophylaxis, would you provide information about RSV to the parents/caregivers?	Yes/No

Figure 1 Barriers to full compliance. Physicians were asked what they believed to be the top three factors that contribute most to noncompliance with recommended palivizumab dosing schedules.

Figure 2 Recommended interventions. Physicians were asked to choose the top three interventions they would recommend to increase full compliance with palivizumab prophylaxis.