Tags

Type your tag names separated by a space and hit enter

Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016.
Open Forum Infect Dis 2019; 6(6):ofz192OF

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.

Authors+Show Affiliations

Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin.Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31205973

Citation

Fowlkes, Ashley L., et al. "Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016." Open Forum Infectious Diseases, vol. 6, no. 6, 2019, pp. ofz192.
Fowlkes AL, Steffens A, Reed C, et al. Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016. Open Forum Infect Dis. 2019;6(6):ofz192.
Fowlkes, A. L., Steffens, A., Reed, C., Temte, J. L., & Campbell, A. P. (2019). Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016. Open Forum Infectious Diseases, 6(6), pp. ofz192. doi:10.1093/ofid/ofz192.
Fowlkes AL, et al. Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016. Open Forum Infect Dis. 2019;6(6):ofz192. PubMed PMID: 31205973.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016. AU - Fowlkes,Ashley L, AU - Steffens,Andrea, AU - Reed,Carrie, AU - Temte,Jonathan L, AU - Campbell,Angela P, AU - ,, Y1 - 2019/04/26/ PY - 2019/02/21/received PY - 2019/04/17/accepted PY - 2019/6/18/entrez PY - 2019/6/18/pubmed PY - 2019/6/18/medline KW - antiviral treatment KW - influenza KW - neuraminidase inhibitors KW - primary care SP - ofz192 EP - ofz192 JF - Open forum infectious diseases JO - Open Forum Infect Dis VL - 6 IS - 6 N2 - 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. SN - 2328-8957 UR - https://www.unboundmedicine.com/medline/citation/31205973/Influenza_Antiviral_Prescribing_Practices_and_the_Influence_of_Rapid_Testing_Among_Primary_Care_Providers_in_the_US_2009_2016_ L2 - https://academic.oup.com/ofid/article-lookup/doi/10.1093/ofid/ofz192 DB - PRIME DP - Unbound Medicine ER -