1. Introduction 1 6 1 6 Karenia brevis 7 12 13 17 1.1. Florida Poison Information Centers The Florida Poison Information Center/Miami (FPIC/Miami) is one of three poison centers created in the State of Florida in 1989 by an act of the Florida Legislature (FS 395.038), and it has rapidly grown into a cost-effective model of a poison center system. The FPIC/Miami is located at the University of Miami Miller School of Medicine and Jackson Health Systems, and directly serves the residents of Southeastern Florida (i.e. Miami-Dade, Broward, Monroe, Palm Beach, Lee and Collier counties) and beyond with toll-free 24 hour/day services in several languages. For example, in 2006 the FPIC/Miami responded to over 57,340 calls; of these calls, 35,741 (62%) were for known or suspected exposures to toxic substances. Approximately 80% of the patients calling from home were managed in the home, without the need for an emergency department visit. The FPIC/Miami placed 18,833 (33%) follow-up calls to continually assess this home management. The FPIC/Miami toxicologists provided over 1,705 consultations with Florida’s physicians to assist in the care of hospitalized patients. In an attempt to prevent poisonings, the FPIC/Miami educators coordinated 669 outreach and education programs for the lay public, health professional, and the media. They also distributed over 198,213 informational brochures, handouts and telephone stickers, reaching over 72,000 persons. http://www.doh.state.fl.us/ENVIRONMENT/community/aquatic/ http://coastwatch.noaa.gov/hab/bulletins_ns.htm http://www.start1.com/ Figure 1 This Pilot Study evaluated whether the new automated system was used by callers and whether the callers considered the information to be useful to them, as well as to collect caller recommendations for the improvement of this service. The goal of this pilot study was to evaluate whether the Florida Aquatic Toxins Hotline was serving the self-identified needs of current callers. 2. Methods The FPIC-Miami receives the telephone numbers of all callers to the Aquatic Toxins Hotline, whether the caller speaks with a Poison Information Specialist or just the automated system. In this evaluation, telephone numbers from the calls made to the Aquatic Toxins Hotline from September 2006 through January 2007 were re-contacted. Of note, throughout this study time period, there was an active Florida red tide on the West Coast of Florida. This evaluation aimed to determine: Basic Caller demographics What information/services callers were seeking Which menu selections were the most commonly chosen Which menu options, in the caller’s opinion, were the most helpful If callers were satisfied with the service provided by the Aquatic Toxins Hotline If callers would call again What would, in the callers’ opinion, make the Aquatic Toxins Hotline service more useful. Trained interviewers contacted the Aquatic Toxins Hotline callers by phone in English and Spanish to explain the study, obtained verbal consent for participation and conducted a short scripted interview (available on request from the corresponding author). Specifically, the interviewers asked a brief series of questions about using the Aquatic Toxins Hotline and about the caller’s perception of the system’s usefulness. Study participants also had an opportunity to make suggestions to improve the system. No personal identifying information was collected. To maximize success in contacting callers, the interviewers called each telephone number three times (once during a week day, once during a week night, and once during the weekend) in an attempt to re-contact the specific person who had called the Aquatic Toxins Hotline. This study was approved by both the University of Miami and Florida Department of Health Human Subject Committees. The data were collected into a Study Access Database. The data were analyzed using SAS version 9.1. The data were analyzed by frequencies as a descriptive process. 3. Results The Aquatic Toxins Hotline has experienced increasing use over the past few years, particularly during periods of active Florida red tides. Since its inception in 1998, there have been 25,000 calls to the Hotline, with 7,000 occurring between 2001 and 2006; during 2006 alone, 2,415 calls were made to the Aquatic Toxins Hotline. During the study period from Sept 2/06 through Jan 31/07, there were 1,163 calls made to the hotline, with 315 (27%) answered by a Poison Information Specialist; of these calls, 53% were for Florida red tide, 6% for ciguatera, 17% for jellyfish, 2% each for PSP/pufferfish, scombroid, and stingrays, and 0.6% blue green algae. This means that only 27% of the callers selected to speak with a Poison Information Specialist from the automated HAB Menu in English or Spanish, while the vast majority (73%) only accessed the automated HAB menu. The Interviewers attempted to contact each of the callers during the study period as described above. Even though the follow-up calls were made within two months of the original contact, only a small percentage (10%) of the callers was able to be re-contacted. Inability to re-contact these individuals was due to a variety of factors such as: no answer despite repeated calls, answering machines, and no real contact number (i.e. original call made from hotel, hospital, etc). Nevertheless, once contacted, all callers (100%) agreed to participate. A total of 118 callers were successfully re-contacted and agreed to participate. Of these, only 89 callers reported that they recalled making a call to the Florida Aquatic Toxins Hotline, and thus these 89 callers were considered the participants in this Pilot Study. Of note, both the actual number of respondents and the percentages are reported below because not all subjects answered all the questions. Table 1 The majority of the participants had heard about the Aquatic Toxins Hotline from a website (35 [39%]), newspaper or magazine article (16 [18%]), a friend or personal recommendation (13 [15%]), or a sign (7 [8%]). Many of the participants (38 [48%]) called with general information questions; of note, none of the participants reported calling because they or someone they cared for was sick or believed they had been exposed to a toxin. Table 2 Table 3 At the end of the questionnaire, the participants were asked if there was anything in particular they thought should be done to improve the usefulness of the Florida Freshwater and Marine Health Hotline as an open ended question. The majority of the comments can be summarized as: a) wanting more up-to-date information (particularly geographic location of the Florida red tides) on even a daily basis; and b) wanting to speak with a person directly or listening to an automated system. Specifically, the participants recommended that the Hotline provide the geographic location of the Florida red tides on a map; provide more information to tourists in hotels; and make sure that the Poison Information Specialists were up-to-date with HAB and Florida red tide information. 4. Discussion This study was the first known systematic evaluation of the use of and satisfaction with educational outreach materials for HABs, specifically evaluating callers to an automated Florida Aquatic Toxins Hotline of the South Florida Poison Information Center. The majority (68%) of participants reported that they were satisfied with the information provided by the Aquatic Toxins Hotline; 80% that they would use the Hotline again; and 79% that they would recommend the Hotline to others. Furthermore, even when evaluating the specific services offered by the Aquatic Toxins Hotline automated system (including speaking directly with a Poison Information Specialist), the high level of satisfaction persisted. Of interest, only 8% of participants reporting hearing about the Aquatic Toxins Hotline from signs, with the rest learning about the hotline from a website (39%), newspaper or magazine article (18%), or friend (15%). Our evaluation demonstrated that the primary advantage of the new automated system is that it provided useful HAB information for the large majority of the callers, without requiring contact with a Poison Information Specialist. By decreasing the workload of purely informational calls for the Poison Information Specialists, the Hotline allows the Specialists to focus on those persons who need immediate assistance. 4.1. Limitations 18 19 20 21 20 21 18 19 5. Discussion and Recommendations 22 23 13 23 29