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Treatment of COVID-19 in Nonhospitalized Patients

Joseph Torrisi, PharmD, BCIDP

Clinical Pharmacy Specialist, Infectious Diseases
Grady Health System
Atlanta, Georgia

Joseph Torrisi, PharmD, BCIDP, has no relevant financial relationships to disclose.

View ClinicalThoughts from this Author

Released: November 17, 2022

Key Takeaways

  • Use of timely COVID-19 treatment hinges on identifying high-risk patients and using all qualified healthcare professionals to prescribe these medications.
  • Logistical barriers to using COVID-19 outpatient treatments can be overcome with the education of healthcare professionals and creation of order sets within electronic health records.

How do we increase use of COVID-19 treatment in appropriate patients?
Prioritization of people most at risk for progression to severe disease from COVID-19 will likely provide the most benefit to those who receive treatment. Creating guidance documents, providing education sessions, and integrating patient-specific questions into electronic health record order sets are ways to increase use of COVID-19 treatment in appropriate patients.

The use of toolkits created by organizations such as the Society of Infectious Diseases Pharmacists (SIDP) is an alternative way to assist healthcare professionals (HCPs) in screening patients for treatment eligibility and implementing treatment options. The SIDP toolkit currently includes COVID-19 monoclonal antibody recommendations and soon will include oral antivirals.

Another way to increase use of COVID-19 treatment is by allowing qualified HCPs such as pharmacists to participate in the screening and prescribing of oral treatment options for mild COVID-19. This may be logistically challenging in the community pharmacy setting given the limited ability to access patient records. But for pharmacists who have access to patients’ electronic health records (eg, those who work in ambulatory clinics), there are better opportunities to appropriately assess the patient and accurately prescribe oral antiviral medications.

A final opportunity to increase use of COVID-19 treatment in high-risk patients is through patient education. Educating patients on the efficacy and safety data and the rationale for use of these agents is of utmost importance, as these therapies are not a “one size fits all” treatment. Based on clinical trial data, guidelines recommend nirmatrelvir plus ritonavir and remdesivir as first- and second-line options and note bebtelovimab and molnupiravir as alternatives. There are patient-specific contraindications to the use of nirmatrelvir plus ritonavir and logistical barriers to administering remdesivir. Therefore, alternative agents such as molnupiravir and bebtelovimab should be offered to high-risk patients when necessary and appropriate.

How do we overcome logistical barriers to outpatient treatment?
Delays to the receipt of treatment are related to drug availability, inadequate documentation of patient-specific information, and logistical constraints. For some healthcare systems, treatment stock can be allotted to each site to ensure that patients have access to therapies across the system. Alternatively, health systems may choose to designate “flagship sites” that house and dispense a majority of the treatment stock and would be used as COVID-19 treatment centers.

Educating HCPs about the necessary laboratory values that must be evaluated before prescribing COVID-19 therapies and creating order sets within electronic health records are key to preventing treatment delays. An example of this would be to have a question-based order set that prompts the HCP to answer specific drug-related questions, such as: For molnupiravir, is the patient pregnant? For nirmatrelvir plus ritonavir, what is the patient’s renal function?

Answering these questions a priori means pharmacy verification delays will be mitigated because all of the necessary patient information has been reviewed.

Your Thoughts?
How do you overcome logistical barriers to prescribing or dispensing COVID-19 therapies for nonhospitalized patients? Join the conversation by posting a comment below.

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