Resident Children's Hospital - Los Angeles Children's Hospital of Los Angeles Los Angeles, California, United States
Background: Oseltamivir is often prescribed during influenza season; however, its effectiveness is controversial, and its adverse effects and cost are a burden on patients and the healthcare system. Oseltamivir should be prescribed only when indicated to mitigate negative clinical and financial impact.
Objective: Given oseltamivir’s questionable clinical efficacy and its adverse effects and financial cost, this project sought to improve adherence to the CDC/AAP guidelines for its use.
Design/Methods: Two interventions were used during the 2019-2020 study period: educational sessions and an EMR pop-up. Educational sessions discussed oseltamivir efficacy data and CDC/AAP guidelines for its use. The EMR pop-up was triggered when prescribing oseltamivir, requiring prescribers to select an indication. The number of oseltamivir prescriptions written and percentage of patients with influenza-related diagnoses who received oseltamivir were measured. Prescription and diagnosis data were determined by querying all prescriptions and primary ICD-10 diagnosis codes in the CHLA ED from January-March of 2018-2020. The influenza-related diagnoses included were determined by author consensus. Chart review of a randomized subset of encounters was used to evaluate if patients receiving prescriptions met treatment indications and if the indication chosen in the pop-up agreed with chart data.
Results: The total number of oseltamivir prescriptions decreased by 12.3% in 2020 compared to 2019 and 2018. The percentage of oseltamivir prescriptions for encounters with influenza-related diagnoses also decreased (16.7% in 2020 versus an average of 18% in 2018-2019). Based on chart review, the percentage of encounters where oseltamivir was prescribed without meeting criteria decreased (3.8% in 2020 versus 13.4% in 2019). Adverse effects and cost were not measured directly, but the reduction in overall and non-indicated oseltamivir prescriptions was expected to reduce both. Of note, the onset of the COVID-19 pandemic led to a dramatic decrease in overall ED encounters and those with influenza-associated diagnoses; oseltamivir was prescribed for 8.0% of those encounters (in March 2020), decreased from 17.7% in February 2020. Conclusion(s): This project highlights that educational and technological interventions may increase adherence to treatment recommendations, allowing for higher quality care, but the decrease in prescribing rate with the onset of the COVID-19 pandemic may indicate that the environment has the largest impact on prescribing habits.
Authors/Institutions: Nicholas Rosculet, Children's Hospital of Los Angeles, Los Angeles, California, United States; Matthew Baker, Children's Hospital of Los Angeles, Los Angeles, California, United States; Ameer Mody, Children's Hospital of Los Angeles, Los Angeles, California, United States