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Association of physician experience with a higher prescription rate of anti-influenza agents in low-risk patients

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Abstract

During the influenza season, most patients suspected of having influenza undergo rapid influenza diagnostic tests (RIDTs) in Japan despite their low sensitivity. However, the physician’s actual rationale for prescribing antivirals, besides the results of RIDTs, remains poorly understood. Our study sought to identify the role of clinical information and physicians’ experience in the initiation of anti-influenza agents. We retrospectively reviewed 380 patients who underwent RIDTs at the emergency department of our hospital from September 2018 to May 2019. Data regarding sex, age, etc., which could affect the decision of prescribing antivirals, were extracted from medical records. We performed logistic regression analysis to analyze the concurrent effect of potentially relevant clinical factors, results of RIDTs, and the physician’s status on antiviral prescription. Multivariable analysis revealed that a positive RIDT had the largest effect on antiviral prescription, followed by physician status, high regional influenza activity, and patients’ presentation within 12 h of symptom onset. Patient’s age, comorbidities, and presentation after 48 h of symptom onset were not associated with antiviral treatment. Physicians with more years of experience were significantly more likely to prescribe antivirals for patients with low risk of complications. Our findings revealed the physicians’ rationale for initiating antiviral treatment and the discrepancy with guideline indications of antivirals, which is the patient’s age and comorbidities. Physicians, especially those with more than 3 years of experience, frequently prescribed antivirals for patients with low risk of complications; thus, educational interventions against this population could be useful to improve this situation.

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Data availability

The data that support the findings of this study are available from the corresponding author, R.S., upon reasonable request.

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Acknowledgements

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General Internal Medicine, Tenri Hospital, 200 Mishima-cho, Tenri-city, Nara, 632-8552, Japan

    Koji Nakajima, Hiroyuki Akebo, Hiroyasu Ishimaru & Ryuichi Sada

  2. Center for Healthcare Education, Tenri Health Care University, Tenri, Nara, Japan

    Yukio Tsugihashi

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  1. Koji Nakajima
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  2. Hiroyuki Akebo
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  3. Yukio Tsugihashi
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  4. Hiroyasu Ishimaru
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  5. Ryuichi Sada
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Contributions

KN; Designed and analyzed the clinical research. Wrote, RS; Supervised the research, All authors contributed to the interpretation of data and writing of the final manuscript. All authors approved the publishing of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Ryuichi Sada.

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The authors declare that they have no conflict of interest.

Statement of human and animal rights

Approval was obtained from the institutional ethics committee of Tenri Hospital (No. 1093). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Consent to publish Written informed consent was waved by the institutional ethics committee due to the retrospective nature of this study.

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Nakajima, K., Akebo, H., Tsugihashi, Y. et al. Association of physician experience with a higher prescription rate of anti-influenza agents in low-risk patients. Intern Emerg Med 16, 1215–1221 (2021). https://doi.org/10.1007/s11739-020-02570-2

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  • DOI: https://doi.org/10.1007/s11739-020-02570-2

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