Q&A: A distribution model for COVID-19 antibody treatments
Clinicians developed a model for distributing COVID-19 neutralizing monoclonal antibody treatments that they said may be useful for other large health systems.
In an article published in Open Forum Infectious Diseases, they examined the allocation and administration of antibody treatments in 35 hospitals and several senior community facilities, skilled nursing facilities and outpatient providers in the University of Pittsburgh Medical Center (UPMC) health system.
“Along with preventative measures such as masks, social distancing and vaccination, as well as the various therapies for inpatient management of COVID-19 patients, passive antibody therapy with monoclonal antibodies provides an option for the treatment of mild to moderately ill outpatients that can prevent progression to hospitalization,” Ryan Bariola, MD FIDSA, a clinical associate professor of medicine in the UPMC division of infectious diseases, and colleagues wrote.
“We await further clinical evidence regarding the benefit of these agents for patients. In the meantime, we share our efforts and learning to aid all in delivering this in a fair, effective manner, and realize it may be a model for other care distribution.”
Healio spoke with Bariola about the distribution model and how it can be applied in other settings.
Healio: What are the strengths of the distribution network highlighted in this article?
Bariola: I think a major strength is that we worked very hard to develop infusion center capacity for these treatments in all the areas of Pennsylvania we serve. Expecting patients with COVID-19 to travel all the way to one central urban site would have decreased access for many of our patients. The vast majority of our patients are currently within one to two counties of an infusion center. Also, we have worked with home health services to deliver this treatment to homebound patients when they don’t have transportation or are too frail to travel to an infusion center. Finally, we strove to make it easy for patients to access the system. We proactively call any eligible patients with positive tests in our health system to discuss this option with them, and we have a 1-800 number so patients outside of our system or without a provider to order this can call for help.
Healio: Can this network be replicated in other areas?
Bariola: I think so. For health systems with several locations, they should strive to decentralize the infusions as much as possible and to think outside of only their largest center. We identified locations for new standup infusion centers when we didn’t already have one in a region we serve. Infection prevention concerns can be addressed by dedicating certain areas of an infusion center to COVID-19 patients or by dedicating certain hours of the day only to patients with COVID-19. Making the process easily accessible for patients is also key. For single hospitals, develop an easy-to-navigate process for your regional providers and patients to access your system.
The FDA allows use of these treatments only within 10 days of symptom onset, and we think earlier is better. Limiting any time delays is critical. At the same time, we must make sure all patients are eligible as per the FDA’s emergency use authorization, so there must a rapid review process included. Finally, it’s critical to spread the word to providers and patients that these treatments are available.
Healio: What specific considerations — geographic, demographic, etc. — need to be made when creating a distribution network like this one?
Bariola: Think about where your patients live, where your infusion centers are and where your COVID-19 hotspots are. Make sure all areas are equally covered with access to an infusion site. Think about the socioeconomic factors of the areas you serve, and address any barriers to care that may exist in some of these areas. Work to make sure all communities you serve are aware of these treatments.
Healio: How did the health system’s administrators adapt the constantly evolving data and studies emerging regarding COVID-19 monoclonal antibody treatments?
Bariola: At UPMC, we have a group of clinical experts that evaluates all possible treatments for COVID-19 and makes systemwide decisions on what to use and what not to use. This group keeps up with current medical literature and oversees decisions about eligibility for this and other treatments. In addition, we must follow the FDA’s guidance on how these treatments can be used.
Healio: What improvements can still be made to this distribution network?
Bariola: The biggest area we are working on to improve is awareness, both from providers and from patients. It can be hard to get attention regarding these treatments. The clinical benefit of these treatments is accumulating, but some providers still are hesitant given concerns about effectiveness. And with the very appropriate attention to vaccination, many members of the public are not aware of this option if they do become infected.