Primary Care

Primary care providers often prescribe antiviral medications inappropriately for influenza patients

Antiviral medications can reduce symptoms, complications, hospitalizations, and deaths from influenza. However, they must be started within 2 days of symptom onset to be effective. Primary care providers are prescribing more antivirals for influenza patients, but often prescribe them inappropriately, concludes a new study. Out of 958 visits with a diagnosis of influenza, clinicians prescribed an antiviral medication to 557 (58 percent) patients. Only 62 percent of these prescriptions were considered appropriate. A team led by Jeffrey A. Linder, M.D., M.P.H., of Harvard Medical School, defined appropriate prescriptions as those given to specific patients. These included patients whose symptoms had lasted for 2 or fewer days, had a fever, and had two or more of the following symptoms: headache, sore throat, cough, or muscle pain.

The most common reason for an antiviral prescription being deemed inappropriate (24 percent of all antiviral prescriptions) was symptoms lasting for more than 2 days. Patients more likely to receive antiviral prescriptions were older patients or those insured by Medicare, and patients with muscle pain or a positive influenza test. (However, 75 percent of patients with a negative test also received a prescription.) Patients who received an antiviral were less likely to have runny or stuffy noses or otherwise look sick. The study also found that the antiviral prescribing rate went from 20 percent in the 2001-2003 influenza seasons to greater than 50 percent by the 2003-2004 season.

Researchers used data collected by the Partners Primary Care Practice-Based Research Network from primary care visits during influenza seasons between October 1, 1999 and May 31, 2007. They selected visits at which the patient received a diagnosis code of influenza, as well as those at which the provider prescribed one of four antiviral medications: amantadine, rimantadine, oseltamivir, and zanamivir.

This research was supported in part by the Agency for Healthcare Research and Quality (HS14563). More details can be found in "Antiviral and antibiotic prescribing for influenza in primary care," by Dr. Linder, Harry Reyes Nieva, B.A., and William A. Blumentals, Ph.D., in the February 2009 Journal of General Internal Medicine, 24(4), pp. 504-510.

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