Comparative Effectiveness Research On Self-collection Versus Health Worker-collection During Swab Examination In Influenza B Virus Infected Patients

Objective: To compare the sensitivity,specificity and consistency of pharyngeal swab self-collection with health worker-collection in the detection results of pharyngeal swabs for influenza B virus infection;to analyze the cost effectiveness,sampling time efficiency and medical staff’s comfort and acceptance by the pharyngeal swab self-collection.Methods:(1)A purposive sampling method was used to select 1066 subjects from November 2021 to January 2022 at a tertiary care hospital in Sichuan Province as study subjects;987 patients attending the fever clinic and 79 medical staff on duty at the hospital,respectively.(2)Using a paired design,987 patients completed pharyngeal swab self-collection and received health worker-collection simultaneously,and the sensitivity,specificity and,consistency and cost-effectiveness of the pharyngeal self-collection were analyzed.(3)The patients and medical personnel were used as study subjects,and the time efficiency of pharyngeal swab self-collection was calculated separately between them.(4)Seventy-nine medical personnel were used as the study subjects,and the general information and the Comfort and Acceptability Questionnaire,which were designed by ourselves in combination with the domestic and international literature,were investigated on the study subjects.Data analysis method: SPSS26.0 and R language were used for data entry and statistical analysis.Results:(1)The sensitivity of the pharyngeal swab self-collection method was 82.1%,and the specificity was 100%.There was good agreement between the pharyngeal swab self-collection and health worker-collection;the agreement result showed a kappa coefficient of0.898(z=28.4,P<0.05).(2)The results of the cost-effectiveness analysis showed that the cost of pharyngeal swab collection per patient was185.82/462+(32.45*4)/4.If interpersonal transmission was not considered and the number of people tested was set to N,the cost model for traditional medical staff sampling was $0.68 N.The results of this paper show that the sensitivity of self-collection is 82.1%,and let the population prevalence be P.Therefore,to detect all the population,the cost model of combining self-collection with medical personnel testing is N(1-82.1%*P)*0.68=N(1-0.821*P)*0.68$.Thus the cost reduction that can be achieved after adopting the pharyngeal swab self-collection approach is $0.56 NP.(3)The time to perform pharyngeal swab self-collection among the general population(63.92±11.95)seconds was significantly higher than that of self-collection among health worker(47.10±7.10)seconds,and the difference was statistically significant(P<0.05).The sampling time between the two groups of medical staff performing pharyngeal swab self-collection and receiving health worker-collection was not statistically significant(P>0.05).There was a significant difference in the time to complete self-collection between different positions,with nurses sampling time significantly lower than clinicians,and the difference was statistically significant(P<0.05).(4)The results of paired statistical analysis of the self-collection scores for nausea,choking and foreign body sensation in the pharynx and the health worker-collection scores showed that the self-collection of pharyngeal swabs resulted in nausea scores of(1.92±0.59),choking scores of(1.73±0.64)and foreign body sensation in the pharynx scores of(1.95±0.56);health worker-collection resulted in nausea(2.18 ± 0.56),choking and coughing(2.10±0.81),and pharyngeal foreign body sensation(2.20±0.47);the comfort of the self-collection of pharyngeal swab was higher than that of health worker-collection,and the difference was statistically significant(P<0.05).(5)Acceptability: 56.95%(45/79)of the subjects considered the pharyngeal swab self-collection completely acceptable;32.92%(26/79)considered the method acceptable;while 10.13%(8/79)maintained a neutral attitude.After training and instruction,65.81% of the collectors thought they could completely master the self-collection;30.37% thought they could master the self-collection.50.63% thought the self-collection was very simple to perform;37.97% thought this method was simple;and only 1.27% thought the self-collection was not simple.Conclusion:(1)Using health worker-collection as the clinical gold standard,self-collection of pharyngeal swabs has better sensitivity,specificity and consistency in influenza B virus detection,and can achieve the detection results of conventional pharyngeal swab sampling.(2)Compared with health worker-collection,patients do not need to wear protective gear for self-collection,which can effectively save protective materials and a lot of human resources for medical institutions.(3)At the same time,the pharyngeal swab self-collection can achieve the sampling efficiency of conventional sampling in the medical staff group,and also has a better comfort and acceptability.