Key Clinical Summary 

• A survey of 684 US health care professionals identified medication interruptions, dose adjustments, and patient reluctance as leading barriers to prescribing COVID-19 antivirals for high-risk outpatients.
• Drug interactions requiring temporary medication interruption (13.9%) or dose adjustment and monitoring (13.5%) received the highest relative importance scores among prescribing barriers.
• Difficulty identifying patients at high risk for severe COVID-19 was another important barrier, highlighting opportunities to improve risk assessment, medication review, and shared decision-making.

Medication management challenges and patient reluctance may contribute to the underutilization of COVID-19 antiviral treatments among high-risk patients, according to research scheduled for presentation at IDWeek 2026.

The findings, presented in the poster Why Are Only a Minority of Eligible Patients Prescribed COVID-19 Antivirals? (P-2145), highlight barriers that may be particularly relevant to clinicians caring for older adults and long-term care residents, who frequently have multiple chronic conditions and complex medication regimens.

Although antiviral treatment can reduce the risk of severe COVID-19 in eligible patients, the researchers noted that only approximately one-third of high-risk patients in the United States receive prescriptions for these medications.

Survey Examines Antiviral Prescribing Decisions

Researchers conducted a 2025 survey of 684 US health care professionals with at least 2 years of clinical experience.

The survey incorporated a best-worst scaling exercise designed to evaluate the relative importance of 13 potential barriers to prescribing COVID-19 antivirals.

Participants completed 20 questions, each presenting 5 potential barriers. Respondents selected the most and least important considerations when making prescribing decisions for high-risk outpatients with COVID-19.

The researchers calculated relative importance scores for each barrier, with percentages totaling 100%.

Survey participants estimated that, during the preceding 12 months, they had discussed or recommended antiviral treatment to a median of 60% of their outpatients with COVID-19. However, they reported prescribing antivirals to a median of only 40% of these patients.

These findings suggest a gap between discussions about antiviral treatment and actual prescribing, although the estimates were based on clinician reports rather than verified prescribing records.

Medication Interactions Present the Greatest Prescribing Challenges

The highest-ranked prescribing barriers involved managing patients' existing medications during antiviral treatment.

The need to interrupt a patient's medication temporarily received the highest relative importance score at 13.9%, followed closely by medications requiring dose adjustments and additional monitoring during antiviral therapy at 13.5%.

These concerns may be particularly relevant in long-term care settings, where residents often receive multiple medications to manage cardiovascular disease, diabetes, neurologic conditions, and other chronic illnesses.

For clinicians, evaluating potential drug-drug interactions can add complexity to time-sensitive antiviral prescribing decisions. Determining whether an existing medication can be safely interrupted, adjusted, or monitored may require coordination among prescribers, pharmacists, and other members of the care team.

The findings suggest that improved access to drug-interaction management resources could help clinicians navigate these decisions and identify appropriate treatment options.

Patient Preferences and Risk Assessment Also Influence Treatment

Patient reluctance was another prominent barrier, receiving a relative importance score of 12.8%.

The researchers identified patients not wanting antiviral treatment as the third-highest-ranked barrier, underscoring the importance of communication and shared decision-making.

Difficulty determining which patients were at high risk for progression to severe COVID-19 was also an important consideration, with a relative importance score of 11.8%.

This finding may be particularly relevant when evaluating older adults with multiple comorbidities, where treatment eligibility and risk assessment require consideration of individual clinical characteristics.

In contrast, concerns about gastrointestinal adverse effects associated with antiviral treatment received a relatively low importance score of 2.2%.

Overall, the findings indicate that prescribing decisions may be influenced more heavily by medication management requirements, patient preferences, and risk assessment challenges than by concerns about gastrointestinal tolerability.

Implications for Long-Term Care Practice

The survey findings highlight several considerations for clinicians managing COVID-19 in nursing homes, assisted living facilities, and other long-term care settings.

Medication reconciliation is an important component of antiviral treatment assessment, particularly among residents receiving multiple prescription medications. Pharmacist involvement may help clinicians identify potential interactions, determine whether temporary medication changes are appropriate, and coordinate monitoring when needed.

The findings also reinforce the importance of early identification of patients who may be eligible for antiviral treatment. Because treatment decisions are time-sensitive, establishing processes for assessing risk and reviewing medication regimens promptly after a COVID-19 diagnosis may help reduce delays.

Shared decision-making is another consideration. Clear discussions about potential treatment benefits, medication adjustments, and patient concerns may help residents and their caregivers make informed decisions.

However, the study surveyed health care professionals treating high-risk outpatients generally and did not specifically evaluate clinicians practicing in long-term care facilities. The findings therefore provide insight into potential challenges in these settings rather than direct evidence of prescribing patterns among long-term care residents.

Additionally, the survey did not evaluate whether specific interventions, such as pharmacist-led medication reviews or educational programs, increased antiviral prescribing or improved patient outcomes.

Conclusion

Medication interruptions, dose adjustments, and patient reluctance were identified as the most important barriers to COVID-19 antiviral prescribing among surveyed US health care professionals.

For long-term care clinicians, the findings underscore the potential value of coordinated medication management, timely risk assessment, and shared decision-making when evaluating antiviral treatment for older adults at risk of severe COVID-19.

Further research focused specifically on long-term care populations could help determine whether targeted strategies improve appropriate antiviral prescribing and reduce COVID-19–related complications.

Reference

Fernandez M, Arham IN, Francis D, et al. Why Are Only a Minority of Eligible Patients Prescribed COVID-19 Antivirals? Poster P-2145. Presented at: IDWeek 2026; October 21-24, 2026; Washington, D.C.