Clinician Perspectives on Monoclonal Antibody Treatment for High-Risk Outpatients with COVID-19: Implications for Implementation and Equitable Access

Kwan, Bethany M.; Sobczak, Chelsea; Beaty, Laurel; Wynia, Matthew K.; DeCamp, Matthew; Owen, Vanessa; Ginde, Adit A.

doi:10.1007/s11606-022-07702-2

Cited by 7 publications

(10 citation statements)

References 31 publications

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“…We recruited clinicians with a range of self-reported mAb knowledge and experience referring patients for mAb treatment, based on our statewide survey. [ 17 ] Interviewee characteristics are displayed in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“… Characteristics obtained from a statewide survey of clinicians in Colorado. [ 17 ] CDPHE = Colorado Department of Public Health and Environment, FQHC = Federally qualified health center, mAb = monoclonal antibodies. …”

Section: Resultsmentioning

confidence: 99%

“…This qualitative study was one part of a large, multi-method NIH-funded project to support rapid, equitable access to mAbs in Colorado, which had the overarching goals of identifying factors related to community and clinician awareness of mAb referral processes and evaluating real-world effectiveness of mAbs for high-risk outpatients with COVID-19. [ 16 ] Results from additional components of the study, including a state-wide clinician survey [ 17 ] and community member surveys and focus groups, [ 18 ] are reported elsewhere. In this study, we used qualitative interviews, guided by the diffusion of innovation (DOI) theory [ 19 ] to identify factors that served as facilitators or barriers to clinicians’ use of mAb referrals and treatment.…”

Section: Methodsmentioning

confidence: 99%

“…We aimed to recruit approximately 36 interview participants [20] who were identified from a state-wide clinician survey about mAb use in Colorado. [17] We purposefully sampled for diversity to understand perspectives across geography (i.e., urban versus rural), practice setting (i.e., community-based clinics, hospital-based outpatient clinics, long-term care facilities, Federally Qualified Health Centers, and emergency departments), clinician specialty, and self-reported mAb knowledge.…”

Section: Samplementioning

confidence: 99%

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

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Samplementioning

confidence: 99%

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

et al. 2022

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“…Rogers’ diffusion of innovations theory was used to guide the design of a community survey and a focus group guide [ 20 ]. A parallel component of the project assessed health care provider perspectives, and informed a provider-level dissemination strategy, reported elsewhere [ 21 ]. This research was approved as exempt human subjects research by the Colorado Multiple Institutional Review Board (COMIRB Protocol #21–2747).…”

Section: Methodsmentioning

confidence: 99%

“All of the things to everyone everywhere”: A mixed methods analysis of community perspectives on equitable access to monoclonal antibody treatment for COVID-19

et al. 2022

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Background Neutralizing monoclonal antibody (mAb) treatment for COVID-19 prevents hospitalization and death but is underused, especially in racial/ethnic minority and rural populations. Reasons for underuse and inequity may include community member lack of awareness or healthcare access barriers, among others. This study assessed mAbs community awareness and opportunities for improving equitable mAb access. Methods A concurrent mixed methods study including surveys and focus groups with adults with high-risk conditions or their proxy decision-makers. Surveys and focus group guides addressed diffusion of innovation theory factors. Descriptive statistics and Fisher’s exact method was used to report and compare survey findings by race and ethnicity. Rapid qualitative methods were used for focus group analysis. Results Surveys from 515 individuals (460 English, 54 Spanish, 1 Amharic), and 8 focus groups (6 English, 2 Spanish) with 69 participants, completed June 2021 to January 2022. Most survey respondents (75%) had heard little or nothing about mAbs, but 95% would consider getting mAb treatment. Hispanic/Latino and Non-Hispanic People of Color (POC) reported less awareness, greater concern about intravenous infusions, and less trust in mAb safety and effectiveness than White, Non-Hispanic respondents. Focus group themes included little awareness but high interest in mAb treatment and concerns about cost and access barriers such as lacking established sources of care and travel from rural communities. Focus groups revealed preferences for broad-reaching but tailored messaging strategies using multiple media and trusted community leaders. Conclusions Despite unfamiliarity with mAb treatment, most respondents were open to receiving mAbs or recommending mAbs to others. While mAb messaging should have broad reach “to everyone everywhere,” racial and geographic disparities in awareness and trust about mAbs underscore need for tailored messaging to promote equitable access. Care processes should address patient-level barriers like transportation, insurance, or primary care access. COVID-19 treatment dissemination strategies should promote health equity.

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A Machine Learning Method for Allocating Scarce COVID-19 Monoclonal Antibodies

Xiao,

Molina,

Aggarwal

et al. 2024

JAMA Health Forum

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ImportanceDuring the COVID-19 pandemic, the effective distribution of limited treatments became a crucial policy goal. Yet, limited research exists using electronic health record data and machine learning techniques, such as policy learning trees (PLTs), to optimize the distribution of scarce therapeutics.ObjectiveTo evaluate whether a machine learning PLT-based method of scarce resource allocation optimizes the treatment benefit of COVID-19 neutralizing monoclonal antibodies (mAbs) during periods of resource constraint.Design, Setting, and ParticipantsThis retrospective cohort study used electronic health record data from October 1, 2021, to December 11, 2021, for the training cohort and data from June 1, 2021, to October 1, 2021, for the testing cohort. The cohorts included patients who had positive test results for SARS-CoV-2 and qualified for COVID-19 mAb therapy based on the US Food and Drug Administration’s emergency use authorization criteria, ascertained from the patient electronic health record. Only some of the qualifying candidates received treatment with mAbs. Data were analyzed between from January 2023 to May 2024.Main Outcomes and MeasuresThe primary outcome was overall expected hospitalization, assessed as the potential reduction in overall expected hospitalization if the PLT-based allocation system was used. This was compared to observed allocation using risk differences.ResultsAmong 9542 eligible patients in the training cohort (5418 female [56.8%]; age distribution: 18-44 years, 4151 [43.5%]; 45-64 years, 3146 [33.0%]; and ≥65 years, 2245 [23.5%]), a total of 3862 (40.5%) received mAbs. Among 6248 eligible patients in the testing cohort (3416 female [54.7%]; age distribution: 18-44 years, 2827 [45.2%]; 45-64 years, 1927 [30.8%]; and ≥65 years, 1494 [23.9%]), a total of 1329 (21.3%) received mAbs. Treatment allocation using the trained PLT model led to an estimated 1.6% reduction (95% CI, −2.0% to −1.2%) in overall expected hospitalization compared to observed treatment allocation in the testing cohort. The visual assessment showed that the PLT-based point system had a larger reduction in 28-day hospitalization compared with the Monoclonal Antibody Screening Score (maximum overall hospitalization difference, −1.0% [95% CI, −1.3% to −0.7%]) in the testing cohort.Conclusions and RelevanceThis retrospective cohort study proposes and tests a PLT method, which can be linked to a electronic health record data platform to improve real-time allocation of scarce treatments. Use of this PLT-based allocation method would have likely resulted in fewer hospitalizations across a population than were observed in usual care, with greater expected reductions than a commonly used point system.

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Clinician Perspectives on Monoclonal Antibody Treatment for High-Risk Outpatients with COVID-19: Implications for Implementation and Equitable Access

Cited by 7 publications

References 31 publications

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

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

“All of the things to everyone everywhere”: A mixed methods analysis of community perspectives on equitable access to monoclonal antibody treatment for COVID-19

A Machine Learning Method for Allocating Scarce COVID-19 Monoclonal Antibodies

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