Preventable Differences in Recommended Outpatient COVID-19 Treatment Among Adults With COVID-19 in the United States

BACKGROUND: The COVID-19 pandemic exposed differences in health care outcomes, including the prescription of COVID-19 antiviral medications. This analysis aimed to describe prescribing patterns in outpatient COVID-19 treatment and assess factors that contributed to these differences. METHODS: A cross-sectional analysis was conducted using electronic health record data from August 2022 through March 2024 from health care institutions participating in PCORnet,® the National Patient-Centered Clinical Research Network. Descriptive statistics were used to characterize COVID-19 outpatients eligible for treatment, and regression models were used to calculate adjusted prevalence ratios (aPR) of prescribed COVID-19 outpatient treatment. Interaction terms assessed the interactions between race and ethnicity and the combined comorbidity index (CCI), age and sex, and age and race and ethnicity. RESULTS: Of 1,247,420 patients eligible for COVID-19 treatment, 334,947 (26.9%) were prescribed outpatient treatment. In adjusted analyses, compared with White patients, all other racial and ethnic groups had lower aPR for treatment (aPRs:0.89-0.99), except patients who reported being multiracial (aPR:1.00; 95% CI: 0.93-1.08). Those aged 65-74 were prescribed treatment more often (aPR: 1.13; 95% CI: 1.12-1.13) compared with patients aged 20-49. Patients with a CCI of 1-3 and ≥4 were prescribed treatment less often (aPR: 0.99, 95% CI: 0.97-1.01 and aPR: 0.91, 95% CI: 0.89-0.94, respectively), compared with those with a CCI of ≤0. These differences were sustained when considering the interactions between race and age and race and CCI. CONCLUSIONS: We found differences in recommended outpatient treatment by several sociodemographic variables. Addressing COVID-19 prescription barriers is essential to slow preventable differences from unmet COVID-19 outpatient care.