Care at home for remdesivir treatment of COVID-19: a survey study of patient and physician experiences.

backgroundDuring the COVID-19 pandemic, remdesivir (RDV) treatment and advanced medical care at home (AMCAH) were pivotal implementations for delivery of comprehensive outpatient services.

methodsA retrospective survey study was conducted to assess patient and physician experiences of RDV treatment. The online/telephone survey questionnaire was developed based on components of the Health Belief Model, Hospital Consumer Assessment of Healthcare Providers (HCAHPS), and physician change management theory. Patients ≥ 18 years of age (N = 1681) who received a three- or five-day RDV treatment regimen at home and prescribing physicians (N = 406) from December 15, 2020-August 31, 2022, in a large integrated non-profit health system were eligible. A cross-sectional analysis was performed to assess the associations of perceptions about value with patient adherence to 100% of prescribed doses, physician adoption of treatment guidelines, and patients’ healthcare utilization. Reduction in COVID-19 related readmission within 30 days of entry into treatment program was also measured. Descriptive statistics were used to describe categorical responses.

resultsOf survey results from 539 patient respondents (response rate: 32%, mean age: 58.4 years (SD 16.2), 55.1% male), race/ethnicity was predominantly Hispanic (48.4%), followed by White (32.3%), and Black (12.6%). Adherence was 87% of patients having completed 100% of RDV doses at home. Patients (79.9%) reporting being “very satisfied” with medical follow-up were less frequently readmitted within 30 days (p < 0.01). Of 140 physician respondents (response rate: 34%, mean age: 46.9 years (SD 8.4), 58% male), race/ethnicity was predominantly Asian (66%), followed by White (23%), and Hispanic (7.1%). Prescribing was associated with feeling knowledgeable about RDV (p < 0.01) and perceived effectiveness for reducing community transmission (p = 0.03).

conclusionsIn racially diverse samples, patients and physicians responded favorably towards AMCAH integrating RDV for treatment of COVID-19. Easy to understand communication and hospital readmission were found to most shape patient satisfaction. AMCAH during the pandemic demonstrated that acute care needs of patients can be safely met at home. These findings inform future design of health care delivery and support expansion for treatment of other acute illnesses. KEY POINTS: QUESTION: What were patient and physician responses to advanced medical care at home integrating RDV for treatment of COVID-19?

findingsIn this survey study, majority of eligible patients (87%) completed 100% home RDV. Patients reported physicians most influenced their decision to accept treatment (70.7%) and high satisfaction with telehealth (95.8%). Patients who reported being “very satisfied” with medical follow-up (81.8%) were less frequently readmitted within 30 days (p<0.01). Physician prescribing of RDV was associated with knowledge (p<0.01) and perceived effectiveness for reducing community transmission (p=0.03). Most physicians reported confidence in nurse capacity (88.2%) and pharmacy services (96.3%) to support care at home.