Research Uncovers Flu Treatment Gaps in High-Risk Adults

INDIANAPOLIS – A multi-state study reveals that many high-risk adults diagnosed with influenza (flu) in emergency departments and urgent care centers are not receiving timely antiviral treatment. Researchers found that only slightly more than half of these patients received antiviral prescriptions, and of those, only 80 percent were filled. This gap in treatment could increase the risk of severe flu complications, particularly for older adults and those with underlying conditions.

The study analyzed prescribing and dispensing patterns of influenza antiviral medications across various demographic groups. Researchers found no significant disparities based on race, ethnicity or socio-economic vulnerability. However, high-risk adults aged 65 and older were less likely to receive timely prescriptions or receive dispensed medications compared to younger high-risk adults.

Patients considered high-risk included those with cardiovascular disease, renal disease, weakened immune systems, or individuals older than the age of 70. For these patients, timely antiviral treatment is critical, as influenza can lead to severe complications beyond the lungs, such as influenza encephalitis, a brain infection that causes inflammation and significant health issues.

"Although effective influenza vaccines are available, many adults remain unvaccinated, and breakthrough cases still occur. Fortunately, we have antivirals that can reduce complications," said study co-author Shaun Grannis, M.D., M.S., vice president for data and analytics at Regenstrief Institute. "This can be a serious disease. Being treated quickly is not only important for individual health but also for public health. If someone has respiratory concerns, I strongly encourage them to contact their healthcare provider as soon as possible."

Patients undergoing rapid flu tests in emergency departments and urgent care centers were more likely to be prescribed and dispensed antivirals. Rapid tests provide results in 5 to 10 minutes, allowing providers to confirm a diagnosis and prescribe antivirals within the recommended 48-hour treatment window.

Antiviral medications work by attacking flu viruses in the body, similar to how antibiotics fight bacterial infections. However, the effectiveness of antivirals declines if treatment begins more than 48 hours after symptoms appear. Many individuals seek care after this window has closed, making providers hesitant to prescribe antivirals. Additionally, some healthcare providers worry about drug interactions, particularly in high-risk patients who take multiple medications (polypharmacy).

The study analyzed electronic health record (EHR) data from 94 urgent care facilities and 142 emergency departments across five states—California, Minnesota, Oregon, Washington, and Wisconsin—through the Centers for Disease Control and Prevention (CDC) VISION Network.

Regenstrief Institute investigators have been pioneers in clinical decision support, and based on the study's findings, Dr. Grannis suggests that decision support tools could help reduce barriers to timely treatment. "By integrating clinical decision support into electronic health records, we can guide providers to ensure high-risk patients receive antiviral treatment when it's most effective," he said.

The study, " Patterns in prescribing and dispensing of influenza antivirals among adults with influenza presenting to urgent care and emergency department settings, VISION Network, 2023–2024 ," was funded by the CDC and is published in Clinical Infectious Diseases.

All authors and affiliations as listed in the paper:

Katherine Adams ¹ , Shikha Garg ¹ , Sara Y Tartof ² , Stephanie A Irving ³ , Malini B DeSilva ⁴ , Nicola P Klein ⁵ , Karthik Natarajan ^{6, 7} , Kristin Dascomb ⁸ , Shaun J Grannis ⁹, Toan C Ong ¹⁰ , S Bianca Salas ² , Lina S Sy ² , Bruno Lewin ² , Lei Qian ² , Allison L Naleway ³ , Padma D Koppolu ³ , Charlene E McEvoy ⁴ , Omobosola Akinsete ⁴ , Inih Essien ⁴ , Bruce Fireman ⁵ , Ousseny Zerbo ⁵ , Karen B Jacobson ⁵ , Julius Timbol ⁵ , Varsha Neelam ¹ , Emily L Reeves ¹ , Monica Dickerson ¹ , Caitlin Ray ¹ , Ruth Link-Gelles ¹¹ , Josephine Mak ¹¹ , Sarah W Ball ¹² , Michael O'Reilly ¹³ , Sonja J Olsen ¹ , Mark W Tenforde ¹.

• ¹ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States.
• ² Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States.
• ³ Kaiser Permanente Center for Health Research, Portland, Oregon, United States.
• ⁴ HealthPartners Institute, Minneapolis, Minnesota, United States.
• ⁵ Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, United States.
• ⁶ Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, United States.
• ⁷ Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, United States.
• ⁸ Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, United States.
• ⁹ Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, United States.
• ¹⁰ School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
• ¹¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States.
• ¹² Westat, Rockville, Maryland, United States.
• ¹³ Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.

About Shaun Grannis, M.D., M.S.

Dr. Shaun Grannis is vice president of data and analytics at Regenstrief Institute, the Regenstrief Chair in Medical Informatics, and a professor of family medicine at the Indiana University School of Medicine.