Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009–2016
Author:
Fowlkes Ashley L1, Steffens Andrea1, Reed Carrie1, Temte Jonathan L2, Campbell Angela P1, Rubino Heather, Heberlein-Larson Lea, Barlow Shari, Reisdorf Erik, Di Lonardo Steve, Martin Karen, Lynfield Ruth, Strain Anna, Boxrud Dave, Baber Jill, Feist Michele, McHugh Lisa, Green Nicole, Selzer Christine, Ledbetter Johnathan, Lojo Jose, Oni Oluwakemi, Thomas Ann, Boulton Rachelle, Kurkjian Katie, Toney Denise, Kelly Sean T, Hamilton Janet, Schroeder Monica,
Affiliation:
1. Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia 2. University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin
Abstract
Abstract
Background
Early influenza antiviral treatment within 2 days of illness onset can reduce illness severity and duration. Reliance on low sensitivity rapid influenza diagnostic tests (RIDTs) to guide antiviral prescribing has been reported. We describe antiviral prescribing practices among primary care providers from a large surveillance network in the United States.
Methods
From 2009–2016, a network of 36 to 68 outpatient clinics per year collected respiratory specimens and clinical data for patients with influenza-like illness (ILI). Specimens were tested for influenza using polymerase chain reaction (PCR). We used multivariable logistic regression to assess factors influencing antiviral prescribing.
Results
Among 13 540 patients with ILI, 2766 (20%) were prescribed antivirals. In age groups recommended to receive empiric antiviral treatment for suspected influenza, 11% of children <2 years and 23% of adults ≥65 years received a prescription. Among 3681 patients with a positive PCR test for influenza, 40% tested negative by RIDT. In multivariable analysis, prescription receipt was strongly associated with a positive RIDT (adjusted odds ratio [aOR] 12, 95% CI 11–14) and symptom onset ≤2 days before visit (aOR 4.3, 95% CI 3.8–4.9). Antiviral prescribing was also more frequent among pediatric and private family practice clinics compared with community health centers (aOR 1.9, 95% CI 1.6–2.2, and 1.3, 95% CI 1.1–1.5, respectively).
Conclusion
Primary care providers were more likely to prescribe antivirals to patients with a positive RIDT, but antivirals were prescribed infrequently even to patients in high-risk age groups. Understanding patient and provider characteristics associated with antiviral prescribing is important for communicating treatment recommendations.
Funder
Centers for Disease Control and Prevention
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Cited by
18 articles.
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