Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO.
Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO.
Medicine (Baltimore). 2022 Dec 16;101(50):e32191. doi: 10.1097/MD.0000000000032191.
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.
自 2020 年 11 月以来，针对非住院 COVID-19 患者的中和单克隆抗体治疗已经可用。然而，这些治疗方法并未得到充分利用，而且获得途径也不公平。为了从临床医生的角度了解促进或阻碍单克隆抗体转介、患者获得治疗机会以及公平性的因素，从而为科罗拉多州改善 COVID-19 治疗方法的获得途径提供以临床医生为重点的信息、材料和流程，我们采访了 38 名有在门诊环境中照顾 COVID-19 患者经验的一线临床医生。临床医生是为了多样性而有目的抽样的，以了解来自不同地理位置（即城市与农村）、实践环境、专业以及自我报告的单克隆抗体知识的观点。访谈于 2021 年 6 月至 9 月之间进行，持续 21 至 62 分钟，并进行了音频记录和逐字转录。然后使用快速定性分析对访谈记录进行分析，以确定主题内容，并比较不同实践环境和其他变量的主题。临床医生认为单克隆抗体非常有效，并且不担心其紧急使用状况；因此，这些因素并未被认为阻碍患者转介。然而，一些获得途径的障碍-包括转介的复杂和不断变化的后勤工作，以及输注所需的时间和设施-阻碍了广泛使用。小型独立和农村诊所的临床医生遇到了独特的挑战，例如缺乏对患者 COVID-19 检测结果的了解、与治疗分配系统脱节以及患者需要长途跋涉才能获得治疗。许多临床医生一直认为单克隆抗体供应短缺；这种信念阻碍了转介，即使单克隆抗体剂量并不稀缺。在所有实践环境中，获得单克隆抗体的最重要促进因素是在医疗服务中连接 COVID-19 检测和治疗。尽管临床医生认为单克隆抗体是 COVID-19 的安全有效治疗方法，但个人和系统层面的障碍阻碍了转介，特别是在某些实践环境中。皮下或口服制剂可能会克服某些获得途径的障碍，但通过将检测与降低发病率和死亡率的治疗方法结合起来，简化患者获得途径，对于应对 COVID-19 和未来的大流行将是至关重要的。
