570: CLINICIAN EXPERIENCES RELATED TO REQUESTS FOR IVERMECTIN AND HEALTHCARE DISTRUST IN THE RURAL SOUTH

Abstract

Introduction: Ivermectin has been widely requested or prescribed as treatment for COVID-19 despite NIH and WHO recommendations against its use. Even so, clinicians commonly receive requests for unproven COVID-19 therapies (UCTs) and face substantial disruption to the therapeutic alliance when clinicians deny these requests from patients. Methods: This study was conducted from 2021-2022 in Moultrie, Georgia. Physicians or advanced practice clinicians who treated a COVID-19-positive patient in the health system were eligible. Purposive, convenience sampling was used to recruit clinicians to participate in a 30-minute qualitative interview exploring experiences and thoughts related to UCT requests, patient trust in the healthcare system, and personal impact of distrust and UCT requests. Thematic analysis was applied to transcripts. Results: Participants were 8 clinicians (7 physicians, 1 advanced practice nurse) from several fields (outpatient setting=2, inpatient or mixed setting=6): pulmonary/critical care (n=3), internal medicine/hospitalists (n=2), nephrology (n=1), and family medicine (n=2). Five themes emerged: 1) Clinicians do not understand why people trust social media and not their clinical expertise; such distrust is hurtful and frustrating; 2) Clinicians feel ambivalence about discussions about UCTs and are generally accepting of community beliefs; 3) Clinicians perceived that distrust in healthcare originates outside of the healthcare system yet patients exhibit trust within the local healthcare system; 4) Clinicians are torn about whether to use UCTs to build trust and rapport; 5) Counseling strategies are variable yet clinicians spend significant time focusing on education. Conclusions: Clinicians experience distress related to perceived patient distrust in their recommendations about COVID-19 vaccination and UCT requests. Some clinicians perceive that acquiescing to UCT requests may help repair therapeutic relationships with minimal harm. Clinician perspectives are aligned with themes from a related study of patient trust and UCT request from the same healthcare system. Taken together, these studies provide insight for clinicians looking to craft savvy and ethical messages that are responsive to patient needs while upholding professional standards in prescribing medications.