Antiviral and antibiotic prescribing for influenza in primary care

Journal Name: 
J Gen Intern Med
Authors: 
Linder,J.A.
Nieva,H.R.
Blumentals,W.A.
Abstract: 
BACKGROUND: Anti-influenza antiviral medications reduce influenza-related morbidity, but may often be used inappropriately. OBJECTIVE: To measure the rate of antiviral and antibiotic prescribing, the appropriateness of antiviral prescribing, and evaluate independent predictors of antiviral and antibiotic prescribing for influenza in primary care. DESIGN AND PATIENTS: Retrospective analysis of 958 visits of clinician-diagnosed influenza in 21 primary care clinics in eastern Massachusetts from 1999 to 2007. We considered antiviral prescribing appropriate if patients had symptoms for 2 or fewer days, had fever, and any 2 of headache, sore throat, cough, or myalgias. MEASUREMENTS AND MAIN RESULTS: Clinicians prescribed antivirals in 557 (58%) visits and antibiotics in 104 visits (11%). Of antiviral prescriptions, 38% were not appropriate, most commonly because of symptoms for more than 2 days (24% of antiviral prescriptions). In multivariate modeling, selected independent predictors of antiviral prescribing were symptom duration of 2 or fewer days (odds ratio [OR], 12.4; 95% confidence interval [CI], 8.3 to 18.6), year (OR, 1.4 for each successive influenza season; 95% CI, 1.3 to 1.7), patient age (OR, 1.3 per decade; 95% CI, 1.2 to 1.5), and, compared to having no influenza testing, having a negative influenza test (OR, 5.5; 95% CI, 3.4 to 9.1) or a positive influenza test (OR, 11.4; 95% CI, 6.7 to 19.3). Independent predictors of antibiotic prescribing included otoscopic abnormalities (OR, 3.3; 95% CI, 1.8 to 6.0), abnormal lung examination (OR, 4.0; 95% CI, 2.1 to 6.2), and having a chest x-ray performed (OR, 2.2; 95% CI, 1.3 to 3.8). CONCLUSIONS: Primary care clinicians are much more likely to prescribe antivirals to patients with symptoms for 2 or fewer days, but also commonly prescribe antivirals inappropriately
4
2009
Volume: 
24
Pages: 
504-510
Keywords: 
1620, abnormalities, Adult, analysis, Anti-Bacterial Agents, Antiviral Agents, Boston, Child, Cough, Drug Therapy, electronic, Female, Fever, Headache, hospital, Humans, Influenza, Influenza,Human, Male, Massachusetts, Medicine, Morbidity, Odds Ratio, patient, Patients, Prescriptions, primary care, Primary Health Care, Research, Research Support, Retrospective Studies, support, therapeutic use, women