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Advisory Committee Chair

Andrew C Rucks

Advisory Committee Members

W Jack Duncan

Michael Maetz

Leslie McClure

Nir Menachemi

Document Type

Dissertation

Date of Award

2011

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Influenza is a contagious respiratory illness that affects millions each year. The illness, if not contained, can be a paramount public health threat in the U.S. and the world. Primary care physicians play an essential role in administering antiviral medications as a treatment for influenza yet the factors that influence their prescribing of these medications remain unclear. The present study aims to identify factors associated with physicians' prescribing of antiviral medications in the ambulatory care setting. The data utilized for this study were obtained from the National Ambulatory Medical Care Survey for each influenza season between the years of 2005-2008. The sample population included primary care physicians in the U.S. who diagnosed patients with influenza according to the International Classification of Diseases, 9th Revision, Clinical Modification code 487. First, descriptive characteristics of the sample population were computed. Next, bivariate analyses were performed to identify relationships between the dependent and independent variables. This was followed by multivariable logistic regression analyses with two models: one with no fixed effects and the other including year as a fixed effect. Summary statistics included descriptive statistics, odds ratios, 95% confidence intervals, and cross tabulations in order to assess physician, patient, and health facility characteristics associated with the prescribing of antiviral medications. A large proportion of physicians who diagnosed patients with influenza were in the specialty of family practice. The majority of patients with influenza were female and non-Hispanic. Multivariable logistic regression analysis revealed that race, type of health facility setting, employment status, and metropolitan location were all significantly associated with prescribing antiviral medications. Patients' expected source of payment and geographical location of the health facility were marginally associated with prescribing antiviral medications. By identifying factors associated with physicians' prescribing practices of antiviral medications, a more timely diagnosis and treatment of influenza can occur. Efforts should be targeted to improve physician education and awareness of the illness. Interventions may be implemented to improve the prescribing of antiviral medications and potentially inappropriate prescribing practices.

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