COVID-19 In Outpatient Setting Research Articles

Referrals, access, and equity of monoclonal antibodies for outpatient COVID-19: A qualitative study of clinician perspectives

Neutralizing monoclonal antibody treatments for non-hospitalized patients with COVID-19 have been available since November 2020. However, they have been underutilized and access has been inequitable. To understand, from the clinician perspective, the factors facilitating or hindering monoclonal antibody referrals, patient access, and equity to inform development of clinician-focused messages, materials, and processes for improving access to therapeutics for COVID-19 in Colorado. We interviewed 38 frontline clinicians with experience caring for patients with COVID-19 in outpatient settings. Clinicians were purposely sampled for diversity to understand perspectives across geography (i.e., urban versus rural), practice setting, specialty, and self-reported knowledge about monoclonal antibodies. Interviews were conducted between June and September 2021, lasted 21 to 62 minutes, and were audio recorded and transcribed verbatim. Interview transcripts were then analyzed using rapid qualitative analysis to identify thematic content and to compare themes across practice settings and other variables. Clinicians perceived monoclonal antibodies to be highly effective and were unconcerned about their emergency use status; hence, these factors were not perceived to hinder patient referrals. However, some barriers to access - including complex and changing logistics for referring, as well as the time and facilities needed for an infusion - inhibited widespread use. Clinicians in small, independent, and rural practices experienced unique challenges, such as lack of awareness of their patients' COVID-19 test results, disconnect from treatment distribution systems, and patients who faced long travel times to obtain treatment. Many clinicians held a persistent belief that monoclonal antibodies were in short supply; this belief hindered referrals, even when monoclonal antibody doses were not scarce. Across practice settings, the most important facilitator for access to monoclonal antibodies was linkage of COVID-19 testing and treatment within care delivery. Although clinicians viewed monoclonal antibodies as safe and effective treatments for COVID-19, individual- and system-level barriers inhibited referrals, particular in some practice settings. Subcutaneous or oral formulations may overcome certain barriers to access, but simplifying patient access by linking testing with delivery of treatments that reduce morbidity and mortality will be critical for the ongoing response to COVID-19 and in future pandemics.

Implementing Early Phase Treatments for COVID-19 in Outpatient Settings: Challenges at a Tertiary Care Center in Italy and Future Outlooks.

We present a brief commentary illustrating the current COVID-19 outpatient treatment options in Italy. We also report our experience setting up a service dedicated to these patients in the wake of the rise in COVID-19 cases observed in January 2022. We also gathered data on the daily costs faced by our outpatient service, based at a tertiary care center located in Florence, Italy. We present them with some considerations on future outlooks on the use of outpatient treatment in COVID-19.

Characteristics and outcomes of ambulatory patients with suspected COVID-19 at a respiratory referral center

RationaleSARS-CoV-2 continues to cause a global pandemic and management of COVID-19 in outpatient settings remains challenging. Objective: We sought to describe characteristics of patients with chronic respiratory disease (CRD) experiencing symptoms consistent with COVID-19, who were seen in a novel Acute Respiratory Clinic, prior to widely available testing, emergence of variants, COVID-19 vaccination, and post-vaccination (breakthrough) SARS-CoV-2 infections. Methods: Retrospective electronic medical record data were analyzed from 907 adults with presumed COVID-19 seen between March 16, 2020 and January 7, 2021. Data included demographics, comorbidities, medications, vital signs, laboratory tests, pulmonary function tests, patient disposition, and co-infections. The overdispersed data (aod) R package was used to create a logit model using COVID-19 diagnosis by PCR as the dichotomous outcome variable. Univariate, conventional multivariate and elastic net machine learning were used to analyze data. Results: Male gender, elevated baseline temperature, and respiratory rate predicted COVID-19 diagnosis. Eosinopenia, neutrophilia, and lymphocytosis were also associated with COVID-19 diagnosis. However, asthma and COPD diagnoses were not associated with SARS-CoV-2 PCR positive test. Male gender, low oxygen saturation, and lower forced expiratory volume in 1 s (FEV1) were associated with higher hospital referral. Conclusions: CRD patients with acute respiratory symptoms in the ambulatory setting were more likely to have COVID-19 if male, febrile and tachypneic. Patients with lower pre-morbid FEV1 and lower SPO2 are more likely to be referred to the hospital. A composite of vitals sigs and WBC differential help risk stratify CRD patients seeking care for presumed COVID-19.

COVID-19 Patient Management in Outpatient Setting: A Population-Based Study from Southern Italy.

Evidence on treatments for early-stage COVID-19 in outpatient setting is sparse. We explored the pattern of use of drugs prescribed for COVID-19 outpatients’ management in Southern Italy in the period February 2020–January 2021. This population-based cohort study was conducted using COVID-19 surveillance registry from Caserta Local Health Unit, which was linked to claims databases from the same catchment area. The date of SARS-CoV-2 infection diagnosis was the index date (ID). We evaluated demographic and clinical characteristics of the study drug users and the pattern of use of drugs prescribed for outpatient COVID-19 management. Overall, 40,030 patients were included in the analyses, with a median (IQR) age of 44 (27–58) years. More than half of the included patients were asymptomatic at the ID. Overall, during the study period, 720 (1.8%) patients died due to COVID-19. Azithromycin and glucocorticoids were the most frequently prescribed drugs, while oxygen was the less frequently prescribed therapy. The cumulative rate of recovery from COVID-19 was 84.2% at 30 days from ID and it was lower among older patients. In this study we documented that the drug prescribing patterns for COVID-19 treatment in an outpatient setting from Southern Italy was not supported from current evidence on beneficial therapies for early treatment of COVID-19, thus highlighting the need to implement strategies for improving appropriate drug prescribing in general practice.

Проблема экономической доступности антикоагулянтов при амбулаторно-поликлиническом лечении пациентов с COVID-19

An assessment of the economic availability of direct oral anticoagulants for COVID-19 outpatient treatment was carried out. For each anticoagulant, the average cost of the package and treatment course were determined, the coefficients of availability in relation to the average wage and the minimum living wage were calculated. Based on the results of the study, an ABC analysis was carried out. The costs of dabigatran, apixaban and rivaroxaban were found to be in category A (high cost) in relation to the minimum living wage. The most accessible of the investigated anticoagulants is apixaban 5 mg in a package of 60 tablets, the coefficient of availability of this drug in relation to the average wage was 21.7, in relation to the living wage – 66.1. The low availability of anticoagulants for the course treatment of COVID-19 in outpatient settings justifies the need for the formation of drug programs for COVID-19 outpatient with at the expense of the federal budget.

Experience with the use of glucocorticoids and netakimab in the treatment of patients with COVID-19 in outpatient settings

Goal.Tostudythe efficacyand safety of therapy with netakimab (NTK) and the complex drug — betamethasone dipropionate +betamesone phosphate (B) in patients with COVID-19 in outpatient settings. Materialand methods.A retrospective analysisof the treatment of 12 patients with severe new coronavirus infection who received therapy was performed simultaneously withnetakimab (NTK) (the first administration at a dose of 60–120 mg, if indicated-the second administration at a dose of 60 mg)and a combined drug-betamethasone dipropionate + betamesone phosphate (B), at a dose of 2 ml officialsolution.Treatmentwas performed at 7th (95% CI [6; 10]) day from the beginning of the disease. Repeated administration of NTK was performedin older patients due to insufficienteffectof stopping hyperthermia and/or hypoxemia. A comprehensive examination of patientsbeforeand after NTK + B therapy was performed, which included clinical (assessment of the severity and duration of fever,analysis of gas exchange indicators), instrumental (computed tomography of the lungs) and laboratory methods, includingdetermination of ferritin, IL-6. Results.Simultaneous use of NTK + B therapy resulted in compensation of hyperthermia and/orSpO2> 93% 2.5 (95% CI [1; 3]) days after the first administration, a significant decrease in the level of inflammatory markers,and positive dynamics according to lung CT data. In all cases, increased respiratory support or additional antibiotic therapy,as well as hospitalization, were not required. The search for articles on the topic was carried out in the PubМed database inEnglish and Russian, published in the period from 2001 to 2020.

Ivermectin Use Associated with Reduced Duration of COVID-19 Febrile Illness in a Community Setting

BACKGROUND: SARS-CoV-2 infection (COVID-19) is a potentially lethal disease that may progress into severe respiratory distress syndrome requiring ventilatory support. While azithromycin (AZI) and hydroxychloroquine (HCQ) are considered similar to placebo in COVID-19, other drugs such as ivermectin (IVER), are being repurposed to treat this pandemic. This study was designed to assess the effects of ivermectin on duration of febrile illness and disease outcomes in mild-to-moderate COVID-19 infection in a community setting. METHODS: In this case-control study 95 suspected patients of mild-to-moderate COVID-19 were included. The controls (Group-A) received AZI+HCQ for seven days while the cases (Group-B) received IVER+AZI+HCQ for six days. RESULTS: A total of 41 patients were in Group-B, while 54 patients were in Group-A. Group-B had consistently and significantly shorter span of fever on days 5, 7, 10 and 14, where the logistic regression showed IVER as the major (Exp B 49·55; pCONCLUSIONS: Ivermectin use is associated with reduced duration of febrile illness in COVID-19 in outpatient setting, thus potentially saving precious lives, reducing direct load on healthcare facilities and preventing high cost of management in a community setting.FUNDING: This study did not require any funding.DECLARATION OF INTERESTS: The authors state there is nothing to declare.ETHICS APPROVAL STATEMENT: The Ethical Review Committee of Jinnah Medical and Dental College, Karachi approved the study.

Filling the gaps in the characterization of the clinical management of COVID-19: 30-day hospital admission and fatality rates in a cohort of 118 150 cases diagnosed in outpatient settings in Spain.

BackgroundCurrently, there is a missing link in the natural history of COVID-19, from first (usually milder) symptoms to hospitalization and/or death. To fill in this gap, we characterized COVID-19 patients at the time at which they were diagnosed in outpatient settings and estimated 30-day hospital admission and fatality rates.MethodsThis was a population-based cohort study. Data were obtained from Information System for Research in Primary Care (SIDIAP)—a primary-care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) tests and hospital emergency, inpatient and mortality registers. We included all patients in the database who were ≥15 years old and diagnosed with COVID-19 in outpatient settings between 15 March and 24 April 2020 (10 April for outcome studies). Baseline characteristics included socio-demographics, co-morbidity and previous drug use at the time of diagnosis, and polymerase chain reaction (PCR) testing and results. Study outcomes included 30-day hospitalization for COVID-19 and all-cause fatality.ResultsWe identified 118 150 and 95 467 COVID-19 patients for characterization and outcome studies, respectively. Most were women (58.7%) and young-to-middle-aged (e.g. 21.1% were 45–54 years old). Of the 44 575 who were tested with PCR, 32 723 (73.4%) tested positive. In the month after diagnosis, 14.8% (14.6–15.0) were hospitalized, with a greater proportion of men and older people, peaking at age 75–84 years. Thirty-day fatality was 3.5% (95% confidence interval: 3.4% to 3.6%), higher in men, increasing with age and highest in those residing in nursing homes [24.5% (23.4% to 25.6%)].ConclusionCOVID-19 infections were widespread in the community, including all age–sex strata. However, severe forms of the disease clustered in older men and nursing-home residents. Although initially managed in outpatient settings, 15% of cases required hospitalization and 4% died within a month of first symptoms. These data are instrumental for designing deconfinement strategies and will inform healthcare planning and hospital-bed allocation in current and future COVID-19 outbreaks.

Summary of the World Health Organization’s guidelines for management for patients with coronavirus infection

A brief overview of the guidelines for the management of patients with the new coronavirus infection COVID-19 published by the World Health Organization guidelines in May 2020 is presented. The article covers sections that primarily concern the medical care to patients with COVID-19 in outpatient settings.