Multidisciplinary Stakeholder Approach Successful in Managing Limited COVID-19 Treatment Resources

A multidisciplinary group of stakeholders were able to successfully develop and run a clinic to maximize the efficient use of COVID-19 prophylactic therapies in a rural health-system setting, according to a poster¹ presented at the American Society of Health-System Pharmacists 2022 Midyear Clinical Meeting, held December 4 to 8 in Las Vegas, Nevada.

Because outpatient COVID-19 prophylaxis, such as nirmatrelvir-ritonavir (Paxlovid) and molnupiravir (Lagevrio) can present numerous challenges, researchers sought to describe the process of opening 2 new outpatient clinics at a single health-system for the administration of prophylaxis and treatment monoclonal antibodies to high-risk patients with and without COVID-19.

Stakeholders from Augusta Health in Virginia were assembled, inclusive of an infectious disease physician, the pharmacy director, clinical leaders, an operations coordinator, nurses from the oncology and infusion centers, community outreach leaders, and medical group leadership. Together, 2 pathways for patient referral were implemented.

The first of these pathways was a monoclonal antibody clinic for high-risk patients who were positive for COVID-19 and who were at high risk for disease progression. These patients were referred by community providers, then assessed by a pulmonologist who evaluated patients, conducted telehealth visits, reviewed emergency use authorization (EUA) criteria, obtained consent, and ordered treatments. Treatments were administered by nurses in an off-site clinic.

The second pathway was for high-risk patients who were negative for COVID-19. These patients were referred to the ambulatory infusion center, where they were screened by oncology nurses referencing a list of patients taking immunosuppressive therapies. In this setting, an infectious disease physician conducted a telehealth visit, reviewed the EUA, obtained patient consent, and ordered prophylactic therapy (tixagevimab-cligavimab; Evusheld)

To ensure that the highest-risk patients were initially treated, community providers placed their referral to the pulmonologist at the clinic, who would conduct screening and other evaluative measures.

As of May 2022, the clinics have administered 81 prophylactic doses of tixagevimab-cilgavimab to high-risk COVID-19-negative patients and 1473 monoclonal antibody treatments to patients who tested positive for COVID-19 and who were at high-risk for disease progression. Eighty treatment courses of nirmatrelvir-ritonavir and 3 treatment courses of molnupiravir have been dispensed through the outpatient pharmacy.

“Using a multidisciplinary approach to design clinic referrals, operations, and medication management, we were able to maximize the efficient use of limited resources to meet a community need for COVID-19 prophylaxis and treatments in a rural community,” the researchers concluded.

Reference

1. Lubkowski J. Implementation of outpatient COVID-19 therapeutic prophylaxis and treatments at a mid-size community hospital. Presented at: American Society of Health-System Pharmacists 2022 Midyear Clinical Meeting and Exhibition; December 4-8, 2022; Las Vegas, NV. Poster 4-065.