Influenza testing and antiviral prescribing practices among emergency department clinicians in 9 states during the 2006 to 2007 influenza season.
OBJECTIVE
Influenza causes significant widespread illness each year. Emergency department (ED) clinicians are often first-line providers to evaluate and make treatment decisions for patients presenting with influenza. We sought to better understand ED clinician testing and treatment practices in the Emerging Infections Program Network, a federal, state, and academic collaboration that conducts active surveillance for influenza-associated hospitalizations.


METHODS
During 2007, a survey was administered to ED clinicians who worked in Emerging Infections Program catchment area hospitals' EDs. The survey encompassed the role of the clinician, years since completing clinical training, hospital type, influenza testing practices, and use of antiviral medications during the 2006 to 2007 influenza season. We examined factors associated with influenza testing and antiviral use.


RESULTS
A total of 1,055 ED clinicians from 123 hospitals responded to the survey. A majority of respondents (85.3%; n=887) reported they had tested their patients for influenza during the 2006 to 2007 influenza season (Emerging Infections Program site range: 59.3 to 100%; P<.0001). When asked about antiviral medications, 55.7% (n=576) of respondents stated they had prescribed antiviral medications to some of their patients in 2006 to 2007 (Emerging Infections Program site range 32.9% to 80.3%; P<.0001). A positive association between influenza testing and prescribing antiviral medications was observed. Additionally, the type of hospital, location in which an ED clinician worked, and the number of years since medical training were associated with prescribing antiviral influenza medications.


CONCLUSIONS
There is much heterogeneity in clinician-initiated influenza testing and treatment practices. Additional exploration of the role of hospital testing and treatment policies, clinicians' perception of influenza disease, and methods for educating clinicians about new recommendations is needed to better understand ED clinician testing and treatment decisions, especially in an environment of rapidly changing influenza clinical guidelines. Until influenza testing and treatment guidelines are better promulgated, clinicians may continue to test and treat influenza with inconsistency.
Mueller
Mark R
MR
New Mexico Department of Health, Santa Fe, NM.
Smith
Philip J
PJ
Baumbach
Joan P
JP
Palumbo
John P
JP
Meek
James I
JI
Gershman
Ken
K
Vandermeer
Meredith
M
Thomas
Ann R
AR
Long
Christine E
CE
Belflower
Ruth
R
Spina
Nancy L
NL
Martin
Karen G
KG
Lynfield
Ruth
R
Openo
Kyle P
KP
Kirley
Pamala D
PD
Pasutti
Lauren E
LE
Barnes
Brenda G
BG
Schaffner
William
W
Kamimoto
Laurie
L
D000998:Antiviral Agents; D004196:Disease Outbreaks / Q000517:prevention & control*; D004363:Drug Utilization; D004635:Emergency Medicine; D019983:Guideline Adherence; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D008403:Mass Screening; D010818:Practice Patterns, Physicians'; D014481:United States
D000998:Antiviral Agents