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. 2025 Apr 4:ciaf178.
doi: 10.1093/cid/ciaf178. Online ahead of print.

Patterns in prescribing and dispensing of influenza antivirals among adults with influenza presenting to urgent care and emergency department settings, VISION Network, 2023-2024

Katherine Adams  1 , Shikha Garg  1 , Sara Y Tartof  2 , Stephanie A Irving  3 , Malini B DeSilva  4 , Nicola P Klein  5 , Karthik Natarajan  6   7 , Kristin Dascomb  8 , Shaun J Grannis  9 , Toan C Ong  10 , S Bianca Salas  2 , Lina S Sy  2 , Bruno Lewin  2 , Lei Qian  2 , Allison L Naleway  3 , Padma D Koppolu  3 , Charlene E McEvoy  4 , Omobosola Akinsete  4 , Inih Essien  4 , Bruce Fireman  5 , Ousseny Zerbo  5 , Karen B Jacobson  5 , Julius Timbol  5 , Varsha Neelam  1 , Emily L Reeves  1 , Monica Dickerson  1 , Caitlin Ray  1 , Ruth Link-Gelles  11 , Josephine Mak  11 , Sarah W Ball  12 , Michael O'Reilly  13 , Sonja J Olsen  1 , Mark W Tenforde  1
Affiliations

Patterns in prescribing and dispensing of influenza antivirals among adults with influenza presenting to urgent care and emergency department settings, VISION Network, 2023-2024

Katherine Adams et al. Clin Infect Dis. .

Abstract

Background: We describe prescribing and dispensing patterns of influenza antivirals among patients with laboratory-confirmed influenza within U.S. urgent care and emergency department settings.

Methods: A retrospective cross-sectional study was conducted for encounters from four large, integrated health systems participating in the VISION network of adult patients presenting with acute respiratory illness to urgent cares or emergency departments and with positive influenza virus test results during the 2023-2024 influenza season. The analysis was restricted to adult patients at higher risk of influenza complications based on presence of underlying medical conditions, older age, pregnancy, and severe obesity. We calculated proportions and odds of prescribed and dispensed antivirals by demographic and clinical characteristics.

Results: A total of 10,700 patient encounters were eligible for analysis. Among encounters with a positive standard molecular influenza test result (N=5,231), 58% (range across sites: 47-64%) were prescribed antivirals, with 67% of prescribing occurring on the encounter date. Among those prescribed antivirals (N=3,050), 80% (range across sites: 75-91%) had them dispensed, with 65% of dispensing occurring on the prescription date. Encounters among persons aged ≥65 years had lower odds of same-day prescribing (0.57 [95% CI: 0.42-0.78]) and lower odds of same-day dispensing (0.58 [95% CI: 0.36-0.94]) compared to those 18-49 years.

Conclusions: Gaps in antiviral treatment within urgent care and emergency department settings remain for patients at higher risk of influenza complications, notably among older adults. Strategies to improve earlier initiation of antiviral treatment may help reduce the risk of influenza-associated complications.

Keywords: antivirals; dispensing; influenza; oseltamivir; prescribing.

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Conflict of interest statement

Conflict of Interest Disclosures

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. During the conduct of the study, all Westat, Kaiser Permanente Southern California Department of Research and Evaluation, and Kaiser Permanente Northern California Division of Research affiliated authors reported receiving contractual support from the CDC via payments made to their respective institutions. Additionally, all authors affiliated with Columbia University Irving Medical Center, HealthPartners Institute, Intermountain Healthcare, Kaiser Permanente Center for Health Research, Regenstrief Institute, and University of Colorado Anschutz Medical Campus reported receiving contractual support from the CDC during the conduct of the study, via subcontracts from Westat, Inc. with payments made to their respective institutions. Unrelated to the submitted work, the following disclosures were reported from the past 36 months: SYT reports contracts from GlaxoSmithKline and Pfizer. NPK reports support from Sanofi, Merck, Pfizer, Seqirus, GlaxoSmithKline, Moderna, AstraZeneca and Janssen, and is a member of Board on Population Health and Public Health Practice, National Academies of Science, Engineering, and Medicine, and was on an expert panel sponsored by International Vaccine Institute. SJG reports contracts with National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) and NIH National Institute of Mental Health (NIHM). TCO received consulting fees from Regenstrief Institute and support for travel from Patient-Centered Outcomes Research Institute (PCORI) and Regenstrief Institute, and has a current patent: PCT/US2018/047961. LSS and LQ report contracts from GlaxoSmithKline, Moderna, and Dynavax. CEM reports support from NIH, Department of Defense (DOD), PCORI, Astra Zeneca, and GlaxoSmithKline and is a member of the American Lung Association of Minnesota Board, Minnesota Department of Health Long COVID Advisory Committee, and Minnesota Department of Health Asthma Care Advisory Committee. OZ reports grant number R01AI168373 with the National Institute of Allergy and Infectious Diseases and support from Pfizer. SWB reports contracts with University of Utah and Novavax.. No other disclosures were reported.

Figures

Figure 1.
Figure 1.
Days from date of encounter to influenza antiviral prescription among adult patients at higher risk of influenza complications presenting with acute respiratory illness to urgent cares or emergency departments and with positive standard molecular influenza virus test results and prescribed influenza antivirals (N=3,050), VISION Network, October 1, 2023 through April 30, 2024
Figure 2.
Figure 2.
Days from date of influenza antiviral prescription to influenza antiviral dispensing among adult patients at higher risk of influenza complications presenting with acute respiratory illness to urgent cares or emergency departments and with positive standard molecular influenza virus test results and dispensed influenza antivirals (N=2,434), VISION Network, October 1, 2023 through April 30, 2024
Figure 3.
Figure 3.
Prescribing and dispensing of influenza antivirals by VISION partner, VISION Network, October 1, 2023 through April 30, 2024. Data shown are among adult patients at higher risk of influenza complications presenting with acute respiratory illness to urgent cares or emergency departments and with positive standard molecular influenza virus test results.
Figure 4.
Figure 4.
Adjusted odds ratio of prescribing and dispensing of influenza antivirals by social and clinical characteristics among adult patients at higher risk of influenza complications presenting with acute respiratory illness to urgent cares or emergency departments and with positive standard molecular influenza virus test results, VISION Network, October 1, 2023 through April 30, 2024 Abbreviations: AI/AN = American Indian or Alaska Native; BMI = body mass index; CI = confidence interval; HR-UMCs = underlying medical conditions considered to increase risk of influenza complications; NH = Non-Hispanic; PI = Pacific Islander; SVI = Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Social Vulnerability Index (2020) a Age group models were adjusted for VISION healthcare system, encounter setting, week of the season, number of categories of higher risk underlying medical conditions considered to increase risk of influenza complications (cardiovascular disease except hypertension alone, chronic pulmonary disease including asthma, hematologic disorders including sickle cell, hepatic disorders, immunosuppressing conditions, metabolic disorders including diabetes mellitus, neurologic and neurodevelopment conditions including stroke and other cerebrovascular diseases, and renal disease), race and ethnicity, BMI (continuous), sex, and seasonal influenza vaccination status. Models for race and ethnicity were adjusted for VISION healthcare system, encounter setting, week of the season, number of categories of underlying medical conditions considered to increase risk of influenza complications, age (continuous), BMI (continuous), sex, and seasonal influenza vaccination status. Models for BMI were adjusted for VISION healthcare system, encounter setting, week of the season, number of categories of underlying medical conditions considered to increase risk of influenza complications, race and ethnicity, age (continuous), sex, and seasonal influenza vaccination status. Models for HR-UMCs were adjusted for VISION healthcare system, encounter setting, week of the season, race and ethnicity, age (continuous), BMI (continuous), sex, and seasonal influenza vaccination status. Vaccination models were adjusted for VISION healthcare system, encounter setting, week of the season, number of categories of higher risk underlying medical conditions considered to increase risk of influenza complications, race and ethnicity, age (continuous), BMI (continuous), and sex. b BMI missing for N=457 encounters.
Figure 5.
Figure 5.
Prescribing and dispensing of influenza antivirals, VISION Network, October 1, 2023 through April 30, 2024. Data shown are among adult patients at higher risk of influenza complications presenting with acute respiratory illness to urgent cares or emergency departments and with positive influenza virus test results, from the VISION partner performing multiple types of influenza testing by influenza test type (A), and same-day prescribing and dispensing and influenza test type (B). 5A. By influenza test type 5B. By prescribing on same day of encounter and dispensing on same day of prescription and influenza test type
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