Impact of a Rapid Point of Care Test for Influenza on Guideline Consistent Care and Antibiotic Use

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Figure 1.
Pragmatic trial diagram of recruitment of polymerase chain reaction (PCR) guided and usual care patients across 3 clinics. EHR, electronic health record.

Table 1.

Guide for Determining Guideline Consistency of Treatment

Diagnosis	Guideline Treatment
Diagnosis	Oseltamivir	Antibiotics
Influenza positive (PCR confirmed or final clinical diagnosis)	Consistent (<48 hours onset)	Inconsistent
No influenza, but high risk for pneumonia or other bacterial infection diagnosis	Inconsistent	Consistent
No influenza, low risk for pneumonia and no bacterial infection diagnosis	Inconsistent	Inconsistent

Table 2.

Signs, Symptoms, and Clinic Assignments for polymerase chain reaction (PCR) Guided Care and Usual Care

Characteristic	PCR Guided Care (n = 264)		Usual Care (n = 771)		P value PCR Vs Usual Care
Characteristic	N	Frequency (%)	N	Frequency (%)	P value PCR Vs Usual Care
Cough	264	100.0	771	100.0
Sore throat	253	95.8	726	94.2	.30
Nasal discharge	243	92.1	670	86.9	.03
Headache	234	88.6	620	80.4	<.01
Chills	229	86.7	556	72.1	<.01
Fever	192	72.7	428	55.5	<.01
Congestion	192	72.7	534	69.3	.29
Myalgia	179	67.8	399	51.8	<.01
Pharynx erythema	154	58.3	371	48.1	<.01
Nausea	55	20.8	121	15.7	.06
Enlarged tonsils	29	11.0	81	10.5	.83
Vomit	27	10.2	60	7.8	.22
Unclear lungs	27	10.2	53	6.9	.08
Diarrhea	23	8.7	96	12.5	.10
Pharynx exudate	12	4.6	25	3.2	.33
Tonsillar exudate	7	2.7	35	4.5	.18
Rales	5	1.9	29	3.8	.14
Lung distress	0	0.0	3	0.4	.31
Clinic 1	75	28.4	238	30.9	<.01
Clinic 2	134	50.8	270	35.0
Clinic 3	55	20.8	263	34.1
Duration ≤ 2 days	131	49.6	296	38.4	<.01
>2 days	133	50.4	475	61.6
Day of visit Friday	59	22.4	205	18.7	.20
Day of visit other weekday	205	77.6	627	81.3

Table 3.

Final Adjusted Model^* for the Association between polymerase chain reaction (PCR) Guided Care and Guideline Consistent Care

Sign/Symptom	Estimate (β coefficient)	aOR (95% CI)
PCR guided care	0.22	1.24 (0.83–1.88)
Tonsillar exudate	−1.76	0.17 (0.07–0.39)
Clinic 2	−0.28	0.76 (0.48–1.18)
Clinic 3	0.58	1.79 (1.09–2.93)
Myalgia	0.85	2.35 (1.61–3.42)
Pharynx erythema	−0.60	0.55 (0.37–0.82)
Pharynx exudate	−1.25	0.29 (0.13–0.63)
Rales	−0.98	0.38 (0.17–0.81)
Enlarged tonsils	−0.80	0.45 (0.26–0.78)
Duration of symptoms (≤2 days Vs >2 days)	0.55	1.74 (1.17–2.57)
Unclear lungs	−0.78	0.46 (0.26–0.82)
Intercept	1.49	———————

↵* H-L χ² statistic, 10.9; P = .21; AUROCC, 0.77.
aOR, adjusted odds ratio; CI, confidential interval; PCR, polymerase chain reaction.

Table 4.

Final Adjusted Model^*^† for the Likelihood of Antiviral Prescription

Sign/Symptom	Estimate (β coefficient)	aOR (95% CI)
PCR guided care^†	0.46	1.57 (1.09–2.28)
Myalgia	1.30	3.65 (2.35–5.68)
Duration of symptoms (≤2 days Vs >2 days)	1.77	5.89 (4.18–8.28)
Fever	0.93	2.52 (1.57–4.05)
Tonsillar exudate	−1.67	0.19 (0.05–0.77)
Unclear lungs	1.05	2.86 (1.58–5.17)
Clinic 2	0.13	1.13 (0.75–1.72)
Clinic 3	0.74	2.09 (1.34–3.25)
Nasal discharge	0.80	2.24 (1.19–4.19)
Chills	0.87	2.38 (1.25–4.53)
Enlarged tonsils	−0.71	0.49 (0.25–0.95)
Intercept	−5.13	————

↵* Hosmer-Lemeshow χ² statistic, 3.16; df = 10; P = .92; AUROCC, 0.86.
↵† Unadjusted OR, 2.10 (1.57–2.82).
aOR, adjusted odds ratio; CI, confidential interval; PCR, polymerase chain reaction.

Table 5.

Final Adjusted Model^*^† for the Likelihood of Antibiotic Prescription

Sign/Symptom	Estimate (β coefficient)	aOR (95% CI)
PCR guided care^†	−0.31	0.61 (0.40–0.94)
Tonsil exudate	1.63	5.10 (2.14–12.1)
Pharynx erythema	0.96	2.60 (1.73–3.93)
Pharynx exudate	1.78	5.94 (2.56–13.8)
Duration of symptoms (≤2 days vs >2 days)	−0.73	0.48 (0.33–0.71)
Sore throat	0.60	1.83 (0.63–5.26)
Enlarged tonsils	0.89	2.43 (1.42–4.16)
Unclear lungs	0.79	2.21 (1.26–3.88)
Nasal discharge	−0.65	0.52 (0.31–0.87)
Clinic 2	0.09	1.10 (0.70–1.73)
Clinic 3	−0.44	0.64 (0.39–0.05)
Intercept	−1.99	————

↵* Hosmer-Lemeshow χ² statistic, 6.32; df = 8; P = .61; AUROCC, 0.79.
↵† Unadjusted OR, 0.71 (0.48–1.04).
aOR, adjusted odds ratio; CI, confidential interval; PCR, polymerase chain reaction.

Table 6.

Final Adjusted Model^* for the Likelihood of Return Visit

Sign/Symptom	Estimate (β coefficient)	aOR (95% CI)
PCR guided care	−1.66	0.19 (0.04–0.81)
Day of visit (Friday Vs other weekdays)	1.04	2.83 (1.29–6.19)
Pharynx erythema	0.97	2.65 (1.15–6.10)
Intercept	−4.22	————

↵* Hosmer-Lemeshow χ² statistic, 2.56; P = .63; AUROCC, 0.70.
aOR, adjusted odds ratio; CI, confidential interval; PCR, polymerase chain reaction.

Table 7.

Final Adjusted Model^*^† for the Likelihood of Guideline Consistent Antiviral Prescription

Sign/Symptom	Estimate (β coefficient)	aOR (95% CI)
PCR guided care	0.53	1.71 (1.18–2.46)
Duration of symptoms (≤2 days vs >2 days)	1.76	5.82 (4.14–8.19)
Myalgia	1.29	3.62 (2.32–5.63)
Fever	0.88	2.41 (1.50–3.89)
Enlarged tonsils	−1.04	0.35 (0.20–0.64)
Clinic 2	0.12	1.13 (0.75–1.71)
Clinic 3	0.77	2.15 (1.39–3.35)
Unclear lungs	0.82	2.28 (1.27–4.08)
Nasal discharge	0.79	2.20 (1.18–4.10)
Chills	0.80	2.20 (1.17–4.24)
Intercept	−5.10	—————-