Monday, September 14, 2009

Inappropriate antiviral medications for influenza patients

Today, I received the September edition of AHRQ Research Activities. For one of the first times, an article I'd written was mentioned in this monthly publication—that articlewas on the burden experienced by women with dysfunctional uterine bleeding who are ready for surgery, but before they have surgery.

But that is not what I really want to mention today. Instead, I want to mention the piece highlighting an article written by Dr. Jeffrey Linder and colleagues that originally appearing in the Journal of General Internal Medicine. This highlight piece summarizes the article's findings. The authors studied 958 primary care visits with a diagnosis of influenza and found that at 58 percent of these antiviral medication was prescribed. Not so surprising. The key finding, however, was that only 62 percent of the prescriptions were deemed appropriate. Or, 38 percent of the antiviral prescriptions were inappropriate.

Why were they inappropriate? Most often, about 2 of every three inappropriate prescriptions, the person had already had symptoms for more than 2 days. The antiviral medications that are given for influenza are only effective if the symptoms have gone of for less than 2 days before the prescription is given.

Why would this happen--particularly when many people have to pay at least a part of the prescription price themselves so that it would seem logical that people should only want prescriptions when they are expected to be effective? And, more importantly, why would physicians or other primary care providers who should know better give the prescriptions?

First, people often just want to be able to feel as though they are doing something about being sick. Unfortunately, this desire can override the logic of the antivirals being ineffective.

Second, people don't always believe the medical evidence.

Third, providers want to maintain their relationships with patients and may give in if they want to maintain the relationship with a patient who really desires an antiviral.

Fourth, providers may not know better.

For most of these, it would seem like a potentially cost-effective solution would be to provide more education. That should not cost much. We’d hope that proper information should be sufficient to convince patients to spend less of their own money and to convince providers not to use unnecessary resources. Has anyone tried it? That wasn't mentioned in the issue of AHRQ Research Activities, but it would seem like a useful follow-up study.


  1. Hi Dr. Frick One thing I remember from one of Dr. Singleton's lectures from about 11 years ago was that you can do so much with your prescription pad. One being if the patient really wants a prescription you write the education or teaching/instructions on the prescription this way the patient feels they have left the office visit with something meaningful. Just think this prescription is very cost effective. Secondly, this lecture I never forgot and use when I am confronted with this type of situation.

  2. Cathy--that would be a great approach. It is interesting to consider why that general philosophy of teaching about the appropriateness of prescriptions (and inappropriateness in some cases) is not more common.