title: Rapid influenza diagnostic test use and antiviral prescriptions in outpatient settings pre- and post-2009 H1N1 pandemic.
abstract: BACKGROUND
  Rapid influenza diagnostic tests (RIDTs) can be used at the point-of-care and are often the only influenza tests readily available in outpatient facilities.
  
  
  OBJECTIVE
  To determine the use of RIDTs and antiviral prescription practices in outpatient facilities.
  
  
  METHODS
  Surveys were mailed to U.S. physician's offices, emergency departments, and community health centers in 2008 (pre-2009 H1N1 pandemic) and 2010 (post-2009 H1N1 pandemic). The 2010 survey included questions to evaluate changes in testing and treatment practices among various risk groups subsequent to the 2009 H1N1 pandemic.
  
  
  RESULTS
  In both surveys, respondents using RIDTs relied on RIDT results to guide prescribing antiviral medications. Greater than two-thirds of these respondents reported prescribing antiviral medications both pre- and post-pandemic for patients within 48h of onset of flu-like symptoms with a positive RIDT (69% pre-pandemic; 67% post-pandemic). After the pandemic (2010 survey), outpatient providers also reported prescribing antivirals to those with flu-like symptoms for 31% of children <2 years, 23% of children 2-5 years, 37% of pregnant patients, and 74% of other patients at high risk; while these figures were higher than pre-pandemic, they represent a failure to use CDC guidelines to prescribe antivirals for patients with suspected influenza who are at higher risk for complications.
  
  
  CONCLUSIONS
  Clinicians in outpatient facilities often relied on RIDT findings to aid in making antiviral treatment decisions; however their treatment practices were not always consistent with CDC guidelines. The use of RIDTs and antiviral medicines were influenced by the 2009 H1N1 pandemic.
authors.affiliation: Centre for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-25, Atlanta, GA 30333, United States. Electronic address: low1@cdc.gov.
authors.forename: Laurina O
authors.initials: LO
authors.lastname: Williams
authors.affiliation: Department of Health Services Research, Division of Healthcare Quality Evaluation, The Joint Commission, One Rennaisance Boulevard, Oakbrook Terrace, IL 60181, United States.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Kupka
authors.affiliation: Center for Data Management and Analysis, Division of Healthcare Quality Evaluation, The Joint Commission, One Rennaisance Boulevard, Oakbrook Terrace, IL 60181, United States.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Schmaltz
authors.affiliation: Department of Health Services Research, Division of Healthcare Quality Evaluation, The Joint Commission, One Rennaisance Boulevard, Oakbrook Terrace, IL 60181, United States.
authors.forename: Stacey
authors.initials: S
authors.lastname: Barrett
authors.affiliation: Office of Infectious Diseases, NCIRD, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Uyeki
authors.affiliation: Office of Infectious Diseases, NCIRD, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jernigan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011247:Pregnancy; D055656:Prescriptions / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: H1N1; Influenza; Influenza testing; Rapid influenza diagnostic testing; Rapid influenza testing