Influenza Testing and Antiviral Prescribing Practices Among Emergency Department Clinicians in 9 States During the 2006 to 2007 Influenza Season

Received 14 January 2009; received in revised form 30 June 2009 and 25 August 2009; accepted 18 September 2009.

Study 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.

Conclusion

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.

a New Mexico Department of Health, Santa Fe, NM

b Connecticut Emerging Infections Program, Yale University, New Haven, CT

c Colorado Department of Public Health and Environment, Denver, CO

d Oregon Public Health Division, Portland, OR

e Emerging Infections Program, University of Rochester, Rochester, NY

f Emerging Infections Program, New York State Department of Health, Albany, NY

g Minnesota Department of Health, St. Paul, MN

h Georgia Emerging Infections Program, Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, GA

i California Emerging Infections Program, Oakland, CA

j Tennessee Department of Health, Nashville, TN

k Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, GA

l Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA

Address for correspondence: Laurie Kamimoto, MD, MPH, CDC, Influenza Division, 1600 Clifton Road, MS A-32 Atlanta, GA 30333; 404-639-4653, fax 404-639-3866

Provide feedback on this article at the journal's Web site, www.annemergmed.com.

Supervising editor: Gregory J. Moran, MD

Author contributions: JPB, JIM, KG, ART, RL, WS, and LK conceived the study and designed the survey. MRM, JPB, JPP, KG, MV, ART, CEL, RB, KGM, RL, KPO, PDK, LEP, BGB, and WS supervised or conducted data collection. PJS provided statistical advice on data analysis. MRM drafted the article, and all authors contributed substantially to its revision. LK takes responsibility for the paper as a whole.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

Reprints not available from the authors.

Please see page 33 for the Editor's Capsule Summary of this article.

PII: S0196-0644(09)01557-1

doi:10.1016/j.annemergmed.2009.09.019

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