title: Use of neuraminidase inhibitors in primary health care during pandemic and seasonal influenza between 2009 and 2013.
abstract: BACKGROUND
  In a context of controversy about influenza antiviral treatments, this study assessed primary health-care physicians' prescription of neuraminidase inhibitors (NIs) in France during pandemic and seasonal influenza between 2009 and 2013.
  
  
  METHODS
  This observational study, using data recorded in three national databases, estimated the rate of NI prescription among influenza-like illness (ILI) patients seen in GP and paediatrician consultations, and determined factors associated with this prescription according to a multivariate analysis. NI delivery by pharmacists was also evaluated.
  
  
  RESULTS
  Rates of NI prescription were estimated to be 61.1% among ILI patients with a severe influenza risk factor seen in GP consultation during the A(H1N1)pdm2009 pandemic versus an average rate of 25.9% during the three following seasonal influenza epidemics. Factors associated with NI prescription were a chronic disease in patients under 65 years (OR 14.85; 95% CI 13.00, 16.97) and in those aged 65 and older (OR 7.54; 5.86, 9.70), an age ≥65 years in patients without chronic disease (OR 1.35; 1.04, 1.74), a pregnancy (OR 10.63; 7.67, 15.76), obesity (OR 4.67; 3.50, 6.22) and a consultation during the pandemic A(H1N1)pdm2009 (OR 3.19; 2.93, 3.48). The number of antiviral treatments delivered by pharmacists during the A(H1N1)pdm2009 pandemic was 835 per 100,000 inhabitants, and an average of 275 per 100,000 inhabitants during the three following seasonal influenza epidemics.
  
  
  CONCLUSIONS
  Although physicians seem to follow the recommended indications for NIs in primary health-care practice, this study confirms the low rate of NI prescription to ILI patients with a severe influenza risk factor, especially during seasonal epidemics.
authors: Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Paris, France. thierry.blanchon@upmc.fr.
authors: Thierry
authors: T
authors: Blanchon
authors: Félicité
authors: F
authors: Geffrier
authors: Clément
authors: C
authors: Turbelin
authors: Isabelle
authors: I
authors: Daviaud
authors: Cédric
authors: C
authors: Laouénan
authors: Xavier
authors: X
authors: Duval
authors: Bruno
authors: B
authors: Lambert
authors: Thomas
authors: T
authors: Hanslik
authors: Anne
authors: A
authors: Mosnier
authors: Catherine
authors: C
authors: Leport
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D016208:Databases, Factual; D011307:Drug Prescriptions; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects; D007251:Influenza, Human / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D009439:Neuraminidase / Q000037:antagonists & inhibitors*; D058873:Pandemics; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012307:Risk Factors; D012621:Seasons; D014764:Viral Proteins / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D014764:Viral Proteins; C487630:NA protein, influenza A virus; D009439:Neuraminidase