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Appendix C: Summary Results of Jefferson County, AL
Antiviral Prescribing Survey
There were 204 providers who responded to the antiviral prescribing survey. Of the 204,
180 were included in the data analysis. The exclusion criteria eliminated 24 respondents
who did not see patients for at least 8 hours per week. Providers who did not see patients
with influenza-like illness between the period of October 2008 and April 2009 were
redirected to other questions and were included in the final analysis. The majority of the
respondents were MDs (48.3%) and nurse practitioners (46.1%). Demographic
characteristics are shown in Table 1.
Table 1. Characteristics of survey respondents (N = 180)
Degree
MD/DO
Nurse Practitioner
Physician Assistant
Nursing Home Administer
Other
N
87
83
4
3
3
Percent
48.3
46.1
2.2
1.7
1.7
Practice Type
Family Medicine
Internal Medicine
Pediatrics
OB/GYN
Medical Specialty
Pediatric Sub-specialty
Other
7
12
8
6
22
8
25
8.0
13.6
9.1
6.8
25.0
9.1
39.8
Primary Setting of Practice
Outpatient practice (private)
Outpatient practice (public)
Hospital-based practice
Academic/teaching practice
Other
61
17
33
47
12
35.9
10.0
18.3
26.1
6.7
Years Since Training
0 – 9 years
10 – 19 years
20 – 29 years
30 – 39 years
40+ years
59
51
30
23
7
34.7
30.0
17.6
13.5
4.1
Number of Patients Seen per Week
< 25 per week
25 – 50 per week
51 – 100 per week
> 100 per week
33
55
54
28
19.4
32.4
31.8
16.5
Antiviral Treatment
The majority of respondents (63.5%; n=108) prescribed antiviral medications for
treatment of ILI during the 2008-09 influenza season. Additional data tables are
available in Appendix B. Among providers who prescribed antivirals for treatment,
97.3% prescribed oseltamivir, or Tamiflu, 20% prescribed rimantadine, while few
prescribed flumadine (12%) and zanamivir (12%).
Influenza Testing
Although most respondents (75.7%) indicated that their practice performed on-site
influenza testing, a sizable minority (24.3%; n=18) did not perform such testing.
Prescribing After 48 Hours
Slightly less than half of respondents (45.9%) reported “sometimes” or “usually or
always” prescribing antivirals more than 48 hours after onset of ILI (Table 2). Most
common reasons for prescribing outside of the 48 hour treatment window were:
questionable time of onset (48.6%); some efficacy of medication to relieve symptoms
after 48 hours (40.0%); and patient requested antiviral medication (25.7%).
Table 2. Prescribing frequency after 48 hours of ILI onset
N
Usually or Always
Sometimes
Rarely or Never
Not applicable
4
30
39
1
Percent
5.4
40.5
52.7
1.4
Antibiotics
Approximately 35.7% (n=40) of providers reported prescribing antibiotics to patients
with ILI during the 2008-09 influenza season. Of those, 52.5% reported prescribing
antibiotics to 0-25% of patients with ILI. The most commonly cited reason for
prescribing antibiotics to ILI patients was that the patient had signs/symptoms of
secondary bacterial infection (77.5%; n=31)
Prophylaxis
A notable majority (69.5%; n=116) reported NOT prescribing antivirals for prophylaxis
of healthy individuals while 30.5% (n=51) did prescribe antivirals for prophylaxis during
the 2008-09 influenza season. The major reason for prescribing was to prevent infection
of high-risk family members (71.2%).
Knowledge
When asked to rate their knowledge of the utility of antiviral medications for treatment of
influenza on a scale of 1 (not at all knowledgeable) to 4 (very knowledgeable), a sizable
portion (46.6%; n=75) indicated they were somewhat knowledgeable while 26.7% (n=43)
indicated they were not very knowledgeable. The mean rating was 2.66.
Providers reported using a variety of sources for information about antiviral medications
for influenza (Table 3).
Table 3. Sources of information about antiviral medications
Source
Peer-reviewed journals (e.g. JAMA)
Mass media
Morbidity and Mortality Weekly Report and
Recommendations
Pharmaceutical company representatives
Web-based trainings
Conference and meetings
Consultations with colleagues
Other
“Other” responses include:
CDC and ADPH
VA and AL AMA recommendations
Infectious disease consultations
N
Percent
122
35
66.7
19.1
47
25.7
28
53
81
115
38
15.3
29.0
44.3
62.8
20.8
Additionally, a majority of respondents (83.1%; n=152) indicated that additional
recommendations on appropriate use of antiviral medications would be helpful.
Preparedness
When asked to rate certain aspects of preparedness as strengths at their organization on a
scale of 1 (Not a strength) to 5 (Definite strength), respondents rated the Response plan as
“adequate” (34.5%; n=60); Response training as “adequate” (36.6%; n=63);
Supplies/equipment as “adequate” (31.6%; n=54); Stock of antiviral medications as “not
a strength” (28.8%; n=49); and surge capacity as “adequate” (27.3%; n=47).
Respondents were asked to rate the level of preparedness of the organization in which
they work for a pandemic of influenza on a scale of 1 (Not at all prepared) to 4 (Very
prepared) and 38.5% (n=67) indicated a preparedness level of 3 whereas 35.1% (n=61)
indicated a preparedness level of 2. The mean rating was 2.4.
Lastly, respondents were asked to rate their level of familiarity with the State Pandemic
Operational Plan on a scale of 1 (Not at all familiar) to 4 (Very familiar). Many
respondents (46.3%; n=82) indicated that they were “not at all familiar” with the Plan
whereas 6.2% (n=11) indicated they were very familiar with the Plan. The mean rating
was 1.8.