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Appendix C – Summary Results of Western North Carolina
Antiviral Prescribing Survey
There were 129 providers who responded to the survey and we included 118 respondents
in the analysis. Eleven were excluded because they did not see patients for at least 8
hours per work or did not see patients with influenza-like illness (ILI) between October
2007 and April 2008. The majority of respondents (89.8%) were MDs; 50 percent were
family practitioners (Table 1). The geographic distribution of respondents is shown in
Figure 1.
Table 1. Characteristics of survey respondents (N = 118)
Degree
N
106
7
2
2
1
Percent
89.8
5.9
1.7
1.7
0.8
Family Practice
Pediatrics
Internal Medicine
Emergency Medicine
Obstetrics/Gynecology
Other
Urgent Care
Primary Setting of Practice
59
15
14
11
11
6
2
50.0
12.7
11.9
9.3
9.3
5.1
1.7
Outpatient practice (private)
Hospital-based practice
Academic/teaching practice
Outpatient practice (public)
Other (please specify)
Years Since Training
54
20
18
18
2
48.2
17.9
16.1
16.1
1.8
In Training
0-5 years
6-10 years
11-15 years
16-20 years
21 or more years
Number of Patients Seen Per Week
11
14
25
19
11
32
9.8
12.5
22.3
17.0
9.8
28.6
<25 per week
25-50 per week
51-100 per week
>100 per week
Geographic Area
5
27
55
24
4.5
24.3
49.5
21.6
73
45
61.9
38.1
MD
PA
DO
PhD
Other
Practice Type
Asheville
Other
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Figure 1.
Antiviral Treatment
The vast majority of respondents (87%; n=102) prescribed antiviral medications for
treatment of ILI during the 07-08 influenza season. Obstetrics and gynecology providers
were least likely to prescribe (64%) compared to nearly all family practice providers
(98%). Additional data tables available in Appendix B. Among providers who prescribed
antivirals for treatment, all prescribed oseltamivir, or Tamiflu®, while few prescribed
amantadine (3%) or zanamivir (2%). None reported prescribing rimantadine.
Influenza Testing
Although most respondents (71%) indicated that their practice performed on-site
influenza testing, a sizable minority (28%; n=31) did not perform such testing. The
Centers for Disease Control and Prevention reported similar findings in a recent study of
primary care providers from four states.1 In our study, providers in Asheville were less
likely to report on-site testing than other providers (65% v. 81%).
Antiviral Prophylaxis
Slightly less than one-third of respondents reported “sometimes” or “usually” 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: time of symptom onset was
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questionable (47%); wanted to decrease the risk of transmission to patient’s contacts
(23%); and patient requested antiviral medication (16%).
Table 2. Prescribing frequency after 48 hours of ILI onset
Usually or always
Sometimes
Rarely or never
N
2
33
77
Percent
1.8
29.5
68.8
Prophylaxis
Seventy percent of respondents (n=79) reported prescribing antivirals for prophylaxis
during the 2007-08 influenza season. Reasons for prescribing included: preventing
infection of high-risk family members (87%); controlling an outbreak in an institutional
setting (33%), and preventing infection of health care workers (27%).
Knowledge
When asked to rate their knowledge about usage of antiviral medications for influenza on
a scale of 1 (not at all knowledgeable) to 4 (very knowledgeable), the mean rating was
3.1 (CI: 2.97-3.22). Obstetrics and gynecology providers had the lowest self-rated
knowledge (mean=2.3), while internal medicine providers had the highest (mean=3.5).
There was no appreciable difference in self-rated knowledge by practice setting, years
since training, or geographic area (Appendix B).
Providers reported using a variety of sources for information about antiviral medications
for influenza (Table 3).
Table 3. Sources of information about antiviral medications
Peer-reviewed journals (e.g. JAMA)
Consultation with colleagues
Conferences and meetings
Web-based trainings
Morbidity and Mortality Weekly Report
and Recommendations
Pharmaceutical company representatives
Mass media
Other
N
81
70
50
34
31
Percent
73.6
63.6
45.5
30.9
28.2
25
13
13
22.7
11.8
11.8
Antibiotics
Nearly half of respondents (49%; n = 55) reported prescribing antibiotics to patients with
ILI during the 2007-08 influenza season. Of these, however, most (82%) reported
prescribing antibiotics to 0-25 percent of ILI patients. The most commonly cited reason
for prescribing antibiotics was a patient with signs and symptoms of a secondary bacterial
infection (93%; n=51)
Centers for Disease Control and Prevention. Influenza-testing and antiviral-agent prescribing practices –
Connecticut, Minnesota, New Mexico, and New York, 2006-07 influenza season. MMWR Morb Mortal
Wkly Rep. 2008;57:61-65.
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