Drivers and barriers influencing healthcare provider antiviral prescribing decisions for patients with mild-to-moderate COVID-19: a discrete choice experiment

Effective antivirals for coronavirus disease 2019 (COVID-19) are available, yet uptake among eligible high-risk patients remains limited. This study quantified the impact of patient characteristics on healthcare providers (HCPs)’ stated preferences for antiviral prescribing for outpatients with mild-to-moderate COVID-19. US HCPs completed an online survey, including a discrete choice experiment (DCE) with nine attributes: patient-reported symptom severity, patient antiviral request, drug-drug interactions [DDIs], and clinical risk factors. HCPs also responded to direct elicitation items varying by concomitant medication use. Using choice data from the DCE, stated preferences were analyzed using hierarchical Bayesian modeling to estimate relative importance (RI) for each attribute. Exploratory subgroup analyses compared RI by prescribing volume and practice setting. Direct elicitation data were summarized descriptively. HCPs included in the analyses (N = 684) were from three practice settings: emergency (33.0%), primary (37.6%), and urgent (29.4%) care. Patient-reported symptom severity was the most influential attribute driving antiviral prescribing decisions (RI = 23.9%), followed by immunocompromised status (RI = 18.2%) and patient age (RI = 15.3%). Patient request for antiviral therapy (RI = 9.2%) and potential DDIs (RI = 4.2%) had comparatively lower influence on prescribing decisions. RI estimates varied by practice setting and antiviral prescribing volume. In direct elicitation, most HCPs selected a highly effective oral antiviral, but some preferred alternative therapies when patients were using concomitant medications requiring interruption or dose adjustment. Although guidelines identify underlying medical conditions as key risk factors for severe COVID‑19 progression, HCP prescribing decisions were more strongly influenced by patient‑reported symptom severity than several established clinical risk factors, highlighting opportunities for HCP education on evidence-based antiviral prescribing and DDI management. Despite evidence that underlying chronic conditions increase the risk of severe COVID-19 outcomes, and that guidelines recommend antiviral prescribing based on these conditions, patient-reported symptom severity was the primary driver of healthcare providers’ COVID-19 antiviral prescribing decisions across different practice settings. In contrast, clinical risk factors played a comparatively smaller role. There were also notable differences in the influence of other attributes depending on the practice setting. These findings highlight opportunities for targeted, practice setting–specific healthcare provider education on COVID-19 antiviral eligibility.