Impact of a clinical pharmacist-led COVID-19 treatment consult service in two primary care seniors clinics

Introduction

Healthcare utilization due to COVID-19 infection is more prevalent in the older adult population. Nirmatrelvir/ritonavir is an oral antiviral option that can decrease the hospitalizations in older adults but has many of drug–drug interactions that need evaluation.

Objectives

The objective of this study was to evaluate the impact of a clinical pharmacist COVID-19 treatment consult service.

Methods

Clinical pharmacists were consulted to assess and provide COVID-19 therapy recommendations for adults 65 years and older who tested positive for COVID-19 in two primary care clinics. Recommendations for the most appropriate COVID-19 therapy were sent to the primary care provider for review and discussed with the patient. Healthcare utilization, reinfection with COVID-19, and safety of COVID-19 therapies were evaluated.

Results

One hundred and twenty four patients, average age of 82 years, received clinical pharmacy assessment for COVID-19 therapy. Pharmacists recommended treatment with nirmatrelvir/ritonavir in 80% of patients. Medication modifications due to drug–drug interactions were required in 88% of patients receiving nirmatrelvir/ritonavir. Thirteen patients were recommended or opted to receive alternative COVID-19 treatment while 36 patients declined COVID-19 treatment, despite provider and pharmacist recommendations. Nineteen patients had an emergency department visit or hospitalization related to COVID-19 within 30 days of pharmacy consult; 15 of the patients had been treated with COVID-19 therapy and 4 declined therapy (p = 0.58). Eight patients experienced reinfection with COVID-19. Only one patient reported an adverse event of hives within 30 days of receiving nirmatrelvir/ritonavir therapy.

Conclusion

A pharmacist-led consult service for evaluating and recommending COVID-19 antiviral therapies resulted in successful triage, while balancing management of drug interactions in a high-risk patient population. No significant difference was found in healthcare utilization or reinfection between patients who received a COVID-19 therapy and those who did not.