Linder J A, Chan J C, Bates D W
Division of General Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02120, USA.
J Clin Pharm Ther. 2006 Jun;31(3):245-52. doi: 10.1111/j.1365-2710.2006.00731.x.
Antiviral medications cost-effectively reduce influenza-related morbidity and potentially mortality. We sought to assess the appropriateness of antiviral prescribing for influenza.
We performed a retrospective analysis of visits by adults to primary care clinics during influenza seasons from 1 October 2000 to 31 May 2004 with a claims diagnosis of influenza (n=535) or with an electronic antiviral prescription (n=25). We defined appropriate antiviral prescribing as the patient having (a) symptoms for 2 or fewer days, (b) fever and (c) any two of headache, sore throat, cough, or myalgias.
Physicians diagnosed patients with influenza in 102 of 535 (19%) visits with a claims diagnosis of influenza. Physicians prescribed antivirals at 15 of 102 (15%) of these visits. The addition of 25 additional electronic antiviral prescriptions gave a sample of 127 visits and 40 (31%) antiviral prescriptions. Twenty-eight (70%) antiviral prescriptions were appropriate. Among patients who did not receive antivirals, 21 of 87 (24%) met criteria for appropriate antiviral prescribing. Antiviral prescribing was associated with a shorter median symptom duration (2 days vs. 3 days; P<0.01) and higher median temperature (37.8 degrees C vs. 36.9 degrees C; P<0.01). Physicians prescribed antivirals more frequently to patients who had myalgias (37% vs. 18%; P=0.04) and an influenza test (67% vs. 28%; P<0.01). Physicians prescribed antivirals more frequently to Blacks (44%) and patients with other race/ethnicity (67%) than to Whites (20%) or Hispanics (20%; P<0.0001).
To improve antiviral prescribing for influenza in primary care, interventions need to target the accurate identification of influenza visits, undertreatment, as well as inappropriate treatment.
抗病毒药物能有效降低流感相关的发病率，并有可能降低死亡率。我们旨在评估流感抗病毒药物处方的合理性。
我们对2000年10月1日至2004年5月31日流感季节期间到基层医疗诊所就诊的成年人进行了回顾性分析，这些患者的索赔诊断为流感（n = 535）或有电子抗病毒药物处方（n = 25）。我们将适当的抗病毒药物处方定义为患者具备以下条件：（a）症状持续2天或更少；（b）发热；（c）头痛、喉咙痛、咳嗽或肌痛中的任意两项。
在535例索赔诊断为流感的就诊病例中，医生诊断出102例（19%）患有流感。在这些就诊病例中，医生在102例中的15例（15%）开具了抗病毒药物。另外增加25份电子抗病毒药物处方后，样本量为127次就诊和40份（31%）抗病毒药物处方。28份（70%）抗病毒药物处方是适当的。在未接受抗病毒药物治疗的患者中，87例中有21例（24%）符合适当的抗病毒药物处方标准。抗病毒药物处方与较短的中位症状持续时间（2天对3天；P<0.01）和较高的中位体温（37.8摄氏度对36.9摄氏度；P<0.01）相关。医生更频繁地为有肌痛（37%对18%；P = 0.04）和进行流感检测（67%对28%；P<0.01）的患者开具抗病毒药物。与白人（20%）或西班牙裔（20%；P<0.0001）相比，医生更频繁地为黑人（44%）和其他种族/族裔的患者（67%）开具抗病毒药物。
为改善基层医疗中流感抗病毒药物的处方情况，干预措施需要针对流感就诊的准确识别、治疗不足以及不适当治疗。
