Outpatient Antiviral Prescribing Practices among Providers in the U.S. Influenza Incidence Surveillance Project, 2009–2014
Methods: During 5 influenza seasons (November–March) from 2009–2014, 129 outpatient providers participating in the Influenza Incidence Surveillance Project (IISP) collected respiratory specimens and clinical data for patients of all ages with onset of influenza-like illness (ILI; defined as fever with cough or sore throat) within 7 days. Specimens were tested for influenza using RT-PCR. We evaluated factors associated with antiviral prescribing practices.
Results: Among 8,832 patients with ILI, 1,568 (18%) were prescribed antivirals. In the age groups for whom outpatient antiviral treatment is recommended, 107 (9%) children <2 years and 49 (23%) adults >65 years received an antiviral prescription. Prescribing practices varied by season, from 11% of ILI patients receiving a prescription in 2011-2012, to 23% in 2012-2013. Patients who received prescriptions were more likely to be seen in clinics that received private vs. public funding (20% vs. 13%, p<0.001). Patients deemed by the provider to have moderate or severe illness were more likely to receive an antiviral prescription than patients deemed to have mild illness (28% vs. 15%, p<0.001). Median time from illness onset to visit date among persons treated and not treated was 1 day (IQR 1–2 days) and 2 days (IQR 1–3 days), respectively (p<0.001). Of 5,910 (67%) patients who presented for care <2 days from illness onset; 22% received antiviral prescriptions compared with 9% who presented after 2 days (p<0.001). Among 6,272 patients with rapid influenza testing performed, patients with a positive result were more likely to receive antiviral prescriptions than those with negative tests (51% vs. 9%, p<0.001). Similarly, influenza detection by RT-PCR (unknown to treating provider) was associated with a higher frequency of antiviral prescriptions (37% vs. 8%, p<0.001).
Conclusion: Influenza antivirals were prescribed infrequently for outpatients with ILI, including among high-risk age groups for whom antivirals are recommended. Understanding factors associated with outpatient antiviral prescribing is important for communicating antiviral treatment recommendations.
A. P. Campbell,
A. M. Fry, None
L. Finelli, None