Summary

Antiviral prescription of mild to moderate COVID-19 and adherence to official recommendations in Spanish emergency departments

Cristóbal M. Rodríguez-Leal1-3, Juan González del Castillo4, Pere Llorens5, David Oteo Mata4, Belén Morales Franco6, Diana Moya Olmeda7, Elizabeth Ortiz García8, Octavio José Salmerón Béliz9, Anna Pons Frigola10, Rigoberto Jesús del Rio Navarro11, Hugo Martínez Faya12, Francisco Román5, Beatriz Valle Borrego13, Alejandro Martín-Quirós14, Henrique Villena García del Real15, Ivana Verónica Tavasci López16, María Teresa Sánchez Moreno17, Sara Gayoso Martín18, Martín Sebastián Ruiz Grinspan3, Teresa Pérez Pérez2,19, Rosario Susi García2,19, en nombre del grupo de estudio COVID CODE SPAIN

Affiliation of the authors

1Fundación para la Investigación e Innovación Biomédica del Hospital Universitario Infanta Sofía y Hospital Universitario del Henares, Madrid, Spain. 2Facultad de Estudios Estadísticos, Universidad Complutense de Madrid (UCM), Madrid, Spain. 3Servicio de Urgencias, Hospital Universitario del Henares, Coslada, Madrid, Spain.4Servicio de Urgencias, IdISCC, Hospital Clínico San Carlos, Madrid, Spain. 5Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain. 6Servicio de Urgencias, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain. 7Servicio de Urgencias, Hospital Virgen de la Luz, Cuenca, Spain. 8Servicio de Urgencias, Hospital Santa Bárbara, Soria, Spain. 9Servicio de Urgencias, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain. 10Servicio de Urgencias, Hospital Universitario y Politécnico La Fe, Valencia, Spain. 11Servicio de Urgencias, Hospital Universitario Doctor Peset, Valencia, Spain. 12Servicio de Urgencias, Hospital Universitario de Navarra, Pamplona, Spain. 13Servicio de Urgencias, Hospital Universitario Severo Ochoa, Leganés, Madrid. Universidad Alfonso X El Sabio, Madrid, Spain. 14Servicio de Urgencias, Hospital Universitario La Paz – IDIPAZ, Madrid, Spain. 15Servicio de Urgencias, Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain. 16Servicio de Urgencias, Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain. 17Servicio de Urgencias, Hospital Clínico Universitario de Valencia, Valencia, Spain. 18Servicio de Urgencias, Hospital Universitario El Escorial, El Escorial, Madrid, Spain. 19Instituto de Estadística y Ciencia de Datos. UCM, Madrid, Spain.

DOI

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Quote

Rodríguez-Leal CM, González del Castillo J, Llorens P, Oteo Mata D, Morales Franco B, Moya Olmeda D, et al. Antiviral prescription of mild to moderate COVID-19 and adherence to official recommendations in Spanish emergency departments. Emergencias. 2025;37:095-102

Summary

Objectives.

To analyze the prescription of antiviral therapy for mild to moderate COVID-19 in Spanish emergency departments, the incidence of missed opportunities to prescribe, and associated factors.
Method . Retrospective cross-sectional study in 16 hospital emergency departments. We collected data for adults with mild to moderate COVID-19 confirmed within 7 days of first symptoms. The patients studied were at risk for progression and were treated as outpatients during the first 8 months of 2022. We estimated the incidence of missed opportunities and evaluated associated factors with a Bayesian statistical approach assuming noninformative prior distributions.

Results.

The overall incidence of missed opportunities to prescribe was 33.5% (95% probability interval [PI], 31.7%- 35.3%). Incidences in the 16 hospitals ranged from 17.8% to 50.6%. Adjusted odds ratios (aORs) showed that factors associated with more missed opportunities were age (aOR, 1.021; 95% PI, 1.013-1.029); widening of recommended indications relative to the first period (aOR third period, 2.641 [95% PI, 1.844-3.783]; aOR fourth period, 7.440 [95% PI, 5.352-10.343]; and aOR fifth period, 17.743 [95% PI, 10.821-29.105]); immunosuppression (aOR, 2.698; 95% PI, 2.115-3.443); and fewer vaccine doses relative to no vaccination (aOR 3 doses, 0.287 [95% PI, 0.197-0-417] and aOR 4 doses, 0.115 [95% PI, 0.074-0.179]). Factors associated with increased antiviral prescription were obesity (aOR, 0.735, 95% PI, 0.567-0.952) and the existence of automated clinical pathway alerts (aOR, 0.287; 95% PI, 0.114-0.721).

Conclusions.

The incidence of missed opportunities to prescribe antiviral therapy is high. Incidences vary across hospitals and more often involve the most vulnerable patients

 

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