Despite available effective treatments, a new study reveals that nearly half of high-risk adults diagnosed with influenza in emergency settings aren't receiving the antiviral medications they urgently need.

At a Glance

  • Only slightly more than half of high-risk adults diagnosed with influenza in emergency departments receive antiviral prescriptions, with only 80% of those prescriptions being filled
  • Adults aged 65 and older are less likely to receive timely antiviral treatments compared to younger high-risk adults
  • Antiviral effectiveness significantly diminishes when treatment begins more than 48 hours after symptom onset
  • Rapid influenza testing in emergency settings increases the likelihood of receiving appropriate antiviral prescriptions
  • Seasonal influenza causes an estimated 12,000-79,000 deaths annually in the U.S. alone

Critical Gaps in Emergency Influenza Care

A troubling pattern has emerged in how emergency medical settings treat influenza in vulnerable populations. Recent research reveals significant shortcomings in providing timely antiviral treatment to high-risk adults diagnosed with influenza in emergency departments and urgent care centers. The multi-state study found that only slightly more than half of these vulnerable patients received antiviral prescriptions, and of those prescribed medication, approximately 20% never filled their prescriptions, leaving them at increased risk for serious complications.

High-risk older adults face particularly concerning disparities in care. The study highlighted that adults aged 65 and older were significantly less likely to receive timely prescriptions compared to younger high-risk adults, despite being among the most vulnerable to influenza complications. This gap in care occurs despite clear guidelines from the Infectious Diseases Society of America (IDSA) recommending early antiviral treatment for high-risk patients to reduce symptoms, complications, and mortality.

The Impact of Delayed Treatment

The timing of antiviral treatment represents a critical factor in managing influenza effectively. Antiviral medications show dramatically reduced effectiveness when treatment begins more than 48 hours after symptoms first appear. Unfortunately, many patients seek care after this crucial window has closed, limiting treatment effectiveness. This timing challenge places particular importance on rapid identification and treatment initiation in emergency settings, which often serve as the first point of medical contact during severe illness.

Seasonal influenza poses a substantial health burden, causing an estimated 4.3-23 million medical visits and 12,000-79,000 deaths annually in the United States alone from 2010-2018. Without prompt and appropriate treatment, high-risk patients face a significantly elevated risk of developing severe complications, including potentially fatal conditions like influenza encephalitis and secondary bacterial pneumonia.

Barriers to Effective Treatment

Several factors contribute to the treatment gap for high-risk adults with influenza. Healthcare providers may hesitate to prescribe antivirals due to concerns about potential drug interactions, particularly in older patients who often take multiple medications. The complexity of managing polypharmacy can make clinicians wary of adding another medication that might interact with a patient's existing regimen, even when that medication could provide significant benefits.

The study identified rapid influenza testing as a key factor in improving treatment rates. Emergency departments and urgent care centers that utilized rapid testing were more likely to provide timely antiviral prescriptions to patients. This finding suggests that removing diagnostic uncertainty plays a significant role in provider decision-making about antiviral treatment, and points to one clear avenue for improving care protocols.

Improving Emergency Influenza Treatment

Researchers suggest several approaches to address these treatment gaps. Integrating clinical decision support tools into electronic health records could guide providers in identifying high-risk patients who would benefit from antiviral treatment. These systems could flag patients meeting age or comorbidity criteria for influenza antivirals, helping to overcome treatment hesitancy or oversight during busy emergency department shifts.

Expanding the use of rapid diagnostic testing for influenza in emergency settings represents another promising intervention. The study found clear correlation between diagnostic testing availability and appropriate treatment, suggesting that removing uncertainty about the diagnosis leads to more guideline-concordant care. Implementing standardized protocols for influenza testing in high-risk patients could significantly improve treatment rates.

Increased patient education about the importance of filling prescriptions and beginning treatment promptly could help address the concerning 20% rate of unfilled prescriptions. For many high-risk adults, particularly those with limited mobility or transportation challenges, arranging pharmacy pickup presents a substantial barrier that might be overcome through delivery services or direct dispensing from emergency departments.