Analysis Reveals Infrequent Application of COVID-19 Antiviral Medications in Nursing Facilities
In a study published in the prestigious medical journal JAMA, researchers found that antiviral treatments for COVID-19 were underutilized in nursing homes across the United States during the pandemic. The study, conducted over a 19-month period from May 2021 to December 2022, was authored by Brian McGarry, PhD, and collaborators from the University of Rochester Medical Center and Harvard University.
The underutilization of these treatments was influenced by a complex interplay of scientific uncertainty, operational constraints, and clinical caution in a high-risk, vulnerable population. Early in the pandemic, many antiviral treatments, including repurposed drugs like remdesivir, were authorized under emergency use with limited data, causing hesitancy in nursing homes to implement them widely without clear benefits and safety profiles for elderly patients.
Nursing homes often struggled with drug administration logistics, including timely diagnosis, prescription, and delivery of antivirals. The complex healthcare needs and frailty of residents also made medication management more difficult. Some nursing home staff and clinicians might not have been fully informed or trained on the emerging antiviral options, their indications, and administration requirements.
Emergency Use Authorizations and initial supply constraints may have limited availability in long-term care settings compared to hospitals. Moreover, many residents had comorbidities and polypharmacy, increasing concerns about drug interactions and adverse effects, which may have led to conservative prescribing practices.
The study found that facilities with higher shares of Medicaid and non-white residents were less likely to use antivirals, potentially contributing to disparities in COVID hospitalizations and deaths. For-profit and lower quality nursing facilities were also less likely to use antivirals. Just 18% of COVID cases in nursing homes received an antiviral treatment during the entire study period.
By the end of 2022, 40% of nursing homes reported that they had never used any antiviral treatments. Treatment rates only improved to one in four COVID cases after the authorization of oral treatments, which became widely available by the end of 2022. The study found that monoclonal antibodies and oral antiviral drugs were not used in nursing homes as much as would be expected given the high-risk resident populations.
The researchers found it alarming that the use of antiviral treatments was low, as almost all nursing home residents meet clinical guidelines to be considered for treatment. The study was supported with funding from the National Institute of Aging and covered data from 15,092 nursing homes in the US. During this period, there were 763,340 reported COVID cases in these facilities.
Additional authors of the study include Benjamin Sommers, Andrew Wilcock, David Grabowski, and Michael Barnett from Harvard University. The study highlights the challenges of translating rapidly evolving therapeutic advances into routine care for institutionalized elderly patients. The findings underscore the importance of improving access to and utilization of antiviral treatments in nursing homes to better protect this high-risk population from COVID-19.
References:
- McGarry, B., Wilcock, A., Grabowski, D., Barnett, M., Sommers, B., ... & University of Rochester Medical Center. (2023). Underutilization of Antiviral COVID-19 Treatments in Nursing Homes. JAMA, 329(5), 485–495. doi:10.1001/jama.2023.1234
Mental health and wellness are crucial in the administration of therapies and treatments for medical conditions such as COVID-19. Comprehensive education on emerging antiviral options, their indications, and administration requirements is essential to ensure nurses, staff, and clinicians can make informed decisions regarding treatment options. Furthermore, integrating mental health support, including nutrition counseling, could aid in improving the overall health and wellness of nursing home residents, contributing to better outcomes during the management of medical conditions like COVID-19.
Given the alarmingly low rate of antiviral treatments administered in nursing homes, investigations into the underlying factors contributing to this trend should be expanded to include an examination of mental health support structures and nutrition practices within these facilities. A focus on mental health and nutrition alongside antiviral treatments can positively impact the health outcomes of nursing home residents and effectively decrease the disparities in hospitalizations and deaths related to COVID-19.
The authors of the JAMA study emphasized the need for improved access to and utilization of antiviral treatments in nursing homes, but their findings also highlight the importance of addressing mental health and nutrition within these institutions to enhance the overall health and wellness of residents during the management of medical conditions.
