Interdisciplinary Team Uses Systematic Process to Treat Veterans With COVID-19

A standardized process by an interdisciplinary team that included pharmacists and nurses ensured veterans with COVID-19 were evaluated and treated appropriately, according to findings published in the Journal of the American Pharmacists Association.

“The initial availability and distribution of new therapeutic options for outpatients with mild-to-moderate [COVID-19] was limited by insufficient supply, challenges related to administration and dispensing, and unique clinical considerations of each medication,” researchers said. “Strategies to prioritize patients and implement processes to allocate these scarce resources were required.”

The intervention was implemented at the VA Connecticut Healthcare System (VACHS), which is comprised of 8 primary care sites, outpatient specialty care, an emergency department, an urgent care site, and a tertiary referral hospital.

Interdisciplinary care teams were created to optimize a process for evaluating and treating patients. The teams included emergency department and primary care physicians, pharmacists, and nurses. Providers were offered guidance on clinical considerations for each medication, as information was subject to frequent change, and a centralized process was established to facilitate prescribing. Treatment options included remdesivir, nirmatrelvir/ritonavir, molnupiravir, and sotrovimab.

Providers logged eligibility notes into the electronic health record when patients had a confirmed diagnosis of COVID-19. Pharmacists were then assigned to review each note within 24 hours of entry, determine appropriate dosing, and discuss recommendations with the provider. Pharmacists also had access to medication inventory to check which treatments were in stock.

Additionally, pharmacists conducted a medication review for each patient to identify potential drug interactions with nirmatrelvir/ritonavir. For patients at risk, providers and pharmacists collaborated on drug interaction mitigation strategies, or another treatment was selected.

“Pharmacists were well-qualified to understand the dynamics of the new medications and to collaborate with providers to recommend the most appropriate therapeutic options for each patient,” study authors said.

There were 484 veterans who tested positive at VACHS between January 10, 2022, and March 10, 2022. Providers logged 134 eligibility notes for outpatient treatment, and a retrospective chart review revealed 80 patients were treated with one of the available therapies.

“Of the patients who were treated with a medication, 30 received a 3-day course of remdesivir, 24 were prescribed nirmatrelvir/ritonavir (6 requiring renal dose adjustment), 15 received molnupiravir, and 11 were administered sotrovimab,” authors said. “Fifty-four of the patients for whom requests were entered did not receive treatment.”

Patients who were not treated already showed improvement or resolution of symptoms when they were evaluated, declined medication, or had symptoms for a longer timeframe than that approved for receiving treatment.

“Implementing a standardized approach to the evaluation of these COVID-19 [Emergency Use Authorization] therapeutics ensured timely and appropriate prescribing at VACHS,” researchers concluded. “This process has the potential to not only aid in the delivery of treatments for COVID-19, but for future allocation of any medication requiring prioritization schema due to resource scarcity.”

Reference:
Kravetz JD, Tarabar AF, Dalton R, Kotansky B, Curtin RN. Implementation of a standardized process for outpatient COVID-19 treatments at a Veterans Affairs medical center. J Am Pharm Assoc. Published online June 25, 2022. doi:10.1016/j.japh.2022.06.010