| المؤلفون: |
Coldwell CM; VA New England Healthcare System, Bedford, Massachusetts, USA., Thorsness R; VA New England Healthcare System, Bedford, Massachusetts, USA., Tepper K; VA New England Healthcare System, Bedford, Massachusetts, USA., Evans JS; VA New England Healthcare System, Bedford, Massachusetts, USA., Rovelsky SA; Pharmacy Service, White River Junction VA Medical Center, White River Junction, Vermont, USA., Houranieh AM; Pharmacy Service, VA Boston Healthcare System, Boston, Massachusetts, USA., Strymish JM; Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA., Marrache LT; Office of Integrated Veteran Care, Veterans Health Administration, Washington, District of Columbia, USA., Califano SG; National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina, USA.; General Internal Medicine, Duke University, Durham, North Carolina, USA. |
| مستخلص: |
Background: This project describes a Veterans Health Administration telehealth pilot to facilitate COVID-19 oral antiviral treatment as part of the national test-to-treat (T2T) strategy. The pilot was operationalized for two pilot VA medical centers by the regional clinical contact center (CCC) for a Veteran Integrated Service Network, which offers multiple services through several virtual modalities. Methods: Nurse triage and medical provider evaluation templates were developed for the CCC to standardize clinical interventions with veteran callers reporting positive home COVID-19 test results. When veterans were determined eligible and consented to treatment with an emergency use authorization (EUA) antiviral medication, CCC providers used secure direct messaging for synchronous communication with local pharmacy services to facilitate adjudication and dispensing. Templates for pharmacy documentation and primary care follow-up monitoring were also developed and disseminated. Results: In total, 198 veterans (mean age 65 years, 89% male, 88% non-Hispanic White) were evaluated through telehealth by regional CCC providers using the T2T process and 96% were prescribed an antiviral medication. Primary care follow-up occurred in 86% of cases, a median of 3 days after the telehealth evaluation. The 30-day all-cause hospitalization rate was 1.5% and there were no deaths within 30 days of treatment initiation. Conclusions: Veterans Integrated Service Network's CCC telehealth triage and evaluation processes enabled safe EUA-compliant care delivery, improved evaluator experience and efficiency, and augmented existing EUA processes in place by front-line pharmacy and primary care teams. |
