Primary care physicians’ perspectives on managing mild-to-moderate COVID-19 in populations at risk for progression to severe disease: a survey-based study

BACKGROUND: Antiviral medications are recommended for outpatients with mild-to-moderate COVID-19 at risk for complications. We evaluated the knowledge of primary care physicians (PCPs) regarding mild-to-moderate COVID-19 and its treatment in outpatients at risk for progression to severe disease. METHODS: In this survey-based study, PCPs answered 15 closed-ended questions regarding COVID-19 and its treatment. The predefined sample size was 150. RESULTS: Overall, 150 PCPs completed the questionnaire between 9/2024 and 10/2024; 3.3%, 14.0%, 26.0%, and 56.7% of responders had 0-5, 6-10, 11-20, and ≥ 21 years of medical practice experience, respectively. Overall, 98.0% of participants knew that COVID-19 is not a seasonal disease, 66.7% that COVID-19 poses significant risks for certain people, 32.7% knew the number of COVID-19 deaths in Israel in 2023 was > 500, and only 17.3% read the report published by the Ministry of Health (MoH) showing an increase in COVID-19 cases and hospitalizations in the preceding 2 months. Additionally, only 48.0% were familiar with the MoH recommendations reported that, for treating mild-to-moderate COVID-19 in ambulatory patients at risk of progression to severe disease, they would prescribe antiviral medications. When given a specific case (80-year-old, mild symptoms), only 60.7% would prescribe antiviral treatment. Moreover, 48.7% would recommend an antigen test to patients with COVID-19-like symptoms. Most participants (90.7%) were aware of the differences between the various antiviral medications; 79.3% knew about the efficacy of nirmatrelvir-ritonavir and only 76.7% had some experience with nirmatrelvir-ritonavir. Interestingly, 40.0% responded that drug-drug interactions with nirmatrelvir-ritonavir deter them from using it, and 32.0% were not familiar with tools for managing drug-drug interactions. Lastly, nearly half (47.3%) were not familiar with the recommendations of international health authorities regarding antiviral treatments for COVID-19. CONCLUSIONS: Our study demonstrated gaps in knowledge and awareness regarding COVID-19 burden, treatment, antiviral medications, guidelines for managing mild-to-severe disease, and the handling of relevant drug-drug interactions. These findings highlight the need for targeted educational interventions and improved clinical decision-support tools to facilitate timely and appropriate diagnosis and antiviral use, prevent underdiagnosis, enhance adherence to treatment guidelines, and reduce complications.