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Access to COVID-19 Oral Treatments Meeting - Shared screen with speaker view
Stacey Kokaram
14:04
Agenda6:00 – 6:10 PM: Welcome and Introductions6:10 – 6:25 PM: Overview of Antiviral Medications for COVID-196:25 – 6:40 PM: Access and availability of oral antivirals6:40 – 6:55 PM: Models to Provide Access to Oral Antivirals in Boston and Challenges6:55 – 7:25 PM: Discussion7:25 – 7:30 PM: Next Steps and Closing
Samantha Taylor
14:30
Samantha Taylor, Executive Director, Bowdoin Street Health Center
Stacey Kokaram
14:31
Thank you for joining us today! Please let us know who’s in the room by sharing your name and organization here in the chat.
Rachel Wilson
14:45
Rachel Wilson, President, CIC Health
christine farrell-riley
14:47
Christine Farrell-riley Codman square health center
Eduardo Nettle
15:06
Eduardo Nettle MA DPH, Vaccinine Equity Initiaitve Community Liaison/Boston
Julie Levison
15:10
Julie Levison, ID physician MGH Chelsea HealthCare Center
BERNARD JONES
15:12
Bernie Jones, VP Value-Based Care and Public Policy, Brigham and Women’s Hospital
Sebastian Hamilton
15:14
Sebastian Hamilton, chief pharmacy officer ambulatory pharmacy services, Boston Medical Center
Sara Turley
15:18
Sara Turley, Chief of Staff, CIC Health
Howard Gold
15:21
Howard Gold, MD BIDMC/BILH
Melissa Leaston
15:35
Melissa Leaston, Director of Nursing
Alyssa Ring
15:35
Alyssa Ring, Director of Government Affairs, Beth Israel Lahey Health
Jonathan Pincus
15:44
Jonathan Pincus Primary MD- Codman Square Health Center and Harbor Health Services
Melissa Leaston
15:45
Whittier Street Health Center
Julia Raifman
15:53
Julia Raifman, ScD, Boston University School of Public Health
Marjorie Janvier
16:02
Marjorie Janvier, Clinical Director Adult Medicine, The Dimock Center
Camille Kotton
16:18
Camille Kotton, transplant ID at MGH
Elissa Perkins
16:20
Elissa Perkins, Emergency Medicine physician and Director of Emergency Department Infectious Disease Management, BMC
Lara Jirmanus
16:28
Lara Jirmanus, MD MPH, Cambridge Health Alliance SDOH Provider Lead
Leigh Simmons
16:44
Leigh Simmons, primary care internal medicine at MGH
Patricia McMullin
16:47
Tish McMullin, Conference of Boston Teaching Hospitals
Liana DElia
22:16
Liana D’Elia, RN, MGH Chelsea Adult Medicine
Howard Gold
30:22
Is there any concern that BA.1.1 has any different response to mAbs than BA.1?
Larry Madoff
32:32
Howard, not for the therapeutic monoclonals but yes for Evusheld
Jonathan Pincus
34:18
Given limitations of infusions at many sites can you comment on IM Sitrovimab. While “non inferior” there were more admissions and deaths in the IM arm.Can we reuse the extra nirmatrelvir from patients with CKD and repackage it with ritonavir to expand access?
Daniel Simpson
34:59
what is availability of Paxlovid?
Howard Gold
35:06
Thanks Larry. That's what I thought you said yesterday. Can you cite a reference?
Larry Madoff
38:33
Howard, excellent twitter thread from Jon Li at BWH https://twitter.com/drjli/status/1487479972293853188
Howard Gold
38:49
Thank you!
Larry Madoff
51:21
https://mdphgis.maps.arcgis.com/apps/instant/nearby/index.html?appid=82983fa9f6d44e2aaf1d5bd420aa57ff
Lara Jirmanus
52:30
Are physicians discussing treatment with patients individually, regarding risk profile of molnupiravir at Gothams?
Rachel Wilson
52:32
What are the primary drivers for the current dispensing rates of available doses?
Camille Kotton
52:40
@Larry that’s a very helpful map - here’s the national version (I found helpful for a pt in Florida) https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/
Philip Lederer
52:54
Thanks Dylan. Great talk.
Sebastian Hamilton (BMC)
53:37
Great and thorough information on efficacy of oral agents, roll out plans for high risk to low, supply + accessibility of agents, etc. One major barrier we experienced was community uptake/acceptance of therapy in the very communities hardest hit + high SVI. Was there any anticipation or planning for PSA + community education before agents became available to help with patients agreeing to oral therapy?
Philip Lederer
54:50
I agree more communication would be very helpful.
Jim Morrill
56:04
It would be good to learn best practices across the community health centers (who have clearly effectively rolled this out thus far)-- that could teach those of us about to do this at AMC-licensed health centers.
Lara Jirmanus
58:51
On the primary care end, the tiered recommendations of who should be prescribed which medications in which order, while is helpful can also confuse the process. I.e. As we only order one medicine at a time and how much of which is available, it seems like we should be ordering nirmatrelvir/ritonavir until supply runs out.
Philip Lederer
01:00:36
Community health centers could do a better job communicating with each other and with public health authorities, but more resources would be helpful for this…
Julia Raifman
01:02:50
This question is for the prior speaker — I wonder how you’re preparing for the next surge? Specifically ensuring that people from vulnerable populations have a supply of tests to quickly diagnose cases and reach providers during high demand periods? I appreciated this article on the highest risk people being least likely to access monoclonal antibodies. https://jamanetwork.com/journals/jama/fullarticle/2788904
Claire Pierre
01:04:58
Thank you so much! Would love to know if East Boston had 1 treatment option or multiple? And any preliminary feedback from patients about their experience with the meds? Lastly any race/ethnicity data on the patients who received the meds at East Boston
Jonathan Pincus
01:05:12
How do you manage patients who meet criteria and report a home antigen test that is positive
Leigh Simmons
01:05:12
Are any other state testing sites (not clinic-affiliated) providing information about antivirals and how to access if +?
Julia Raifman
01:06:20
I wonder if a public education campaign about the importance of prompt treatment, and in several languages, may also be helpful? Perhaps it could be combined with information on the importance of vaccines & boosters
Philip Lederer
01:06:43
Agree, Julia!
Camille Kotton
01:07:06
Same, several patients very pleased with outcome
Patricia McMullin
01:07:49
Agree with Julia suggestion
Lara Jirmanus
01:07:53
How does DPH plan to disseminate the information about patient self referral for treatment?
Philip Lederer
01:08:59
Is there a budget for marketing?
Rocio Hurtado
01:10:06
One of the barriers in accessing Mabs for pts from some of our vulnerable communities (esp given high rates of comorbidities and potential drug interactions in complex pts) has been transportation to Mab sites. Are there state-wide efforts on this front (in addition to having sites closer to these communities as you are doing)?
roger pasinski
01:10:13
Jackie,fantastic roll out!
Julia Raifman
01:10:30
Thank you for sharing. Will there be mass media campaigns as well?
Patricia McMullin
01:11:24
Great news on flyers, thank you.
Julia Raifman
01:11:30
The flyers on vaccines are great but hearing many patients have not seen them on the website
Philip Lederer
01:11:31
Good point from Dr Hurtado…
Camille Kotton
01:11:47
@Rocio, I had a pt who got mAb at home via Cataldo. wondering how often that can happen and if for everyone?
Melissa Leaston
01:11:55
Is there a strategy for treating unsheltered individuals ?
Lara Jirmanus
01:12:32
https://drive.google.com/file/d/1ksdNitC1_U7PXM5qmBAIsXJitwyfmpwU/view
Philip Lederer
01:12:47
Agree with Melissa Leaston - homeless and other marginalized populations need a priority…
Lara Jirmanus
01:13:02
The above link was the flyer shared regarding patient self referral
Claire Pierre
01:13:42
Should we consider a multilingual workforce (hotline) who can answer You’re positive now what? And connect people to options and treatment
Julia Raifman
01:14:02
That’s a great idea to have a hotline
Lara Jirmanus
01:14:21
It would also be nice for a DPH dashboard tracking supply of therapeutics. As providers don’t know which sites have how much of what med prior to prescribing.
Melissa Leaston
01:14:28
That's is a great idea
Rocio Hurtado
01:14:54
Huge issue
Julia Raifman
01:15:49
How is the state preparing for the next surge and ensuring vulnerable populations have good access to rapid tests?
Lara Jirmanus
01:15:58
^^^
Larry Madoff
01:16:07
The website actually lists the availability of each therapeutic at each site if you click on them
Marjorie Janvier
01:16:10
Agree with the importance of getting treatment information out to patients...Information at testing sites etc.. to help facilitate
Dylan Tierney
01:16:26
@Rocio Gothams is able to arrange for transport to the Gothams site for patients that cannot arrange transport on their own
Claire Pierre
01:16:44
At MGB we have offered hospital based, CHC based and mobile (van) and continue to find that awareness about the meds and their time sensitivity remains. A proactive outreach to those who are eligible and test positive combined with an easy line for those who test at home (and don’t have a PCP) would be great to increase equity
Philip Lederer
01:17:36
Agree with Julia Raifman - preparing for the next surge - particularly regarding budgets, workplans, helping the homeless/ marginalized etc.
Patricia McMullin
01:19:13
Great suggestion
roger pasinski
01:20:22
Will the mgb vans have the med on the van?
Rajesh Gandhi
01:20:44
I like the idea of distributing information about the treatment with the test kits.
Leigh Simmons
01:20:45
A big concern is reaching people WELL before infection - so that they know to reach out for help if they get sick, and don't miss the treatment window. It's going to need a real change in messaging from our earliest days of not having treatments.Any models out there yet of outreach to unvaccinated patients specifically, to make sure they know to reach out early if unwell?
Philip Lederer
01:21:31
Agree with Leigh. We have lots of patients with low health literacy.
Philip Lederer
01:23:01
Agree with Eduardo Nettle regarding trust.
Leigh Simmons
01:23:44
Philip - problem of not knowing about this (or thinking that the treatments remain completely unavailable) is really pretty widespread. I've had patients who were very surprised to hear that I was recommending a treatment - and glad to receive one - but the messaging is just not getting out there well enough yet.
Patricia McMullin
01:23:49
Thank you BPHC for bringing us together and great presenters.
Julia Raifman
01:24:31
So glad you’re planning for surges
Philip Lederer
01:25:26
Agree with Julia Raifman. And Dr Ojikutu regarding paid sick leave, equity.
Julia Raifman
01:28:57
Yes thank you for highlighting the importance of paid leave, Dr. Ojikutu
roger pasinski
01:30:08
Electronic billboards?
Philip Lederer
01:30:44
Agree with the importance of messaging to marginalized communities in Dorchester, Roxbury, Mattapan, Brockton, etc.Thanks for a great session tonight to Drs Ojikutu, Gandhi, Tierney and others.All hands on deck!
Lara Jirmanus
01:31:00
Would like to echo the paid sick leave. Thank you Dr. Ojikutu. Unfortunately the governor’s address on masks in schools and messaging that COVID is mild makes it difficult for us to appropriately communicate risk to patients (and benefits) of new treatments.
Sebastian Hamilton (BMC)
01:31:16
Agree, be great to be more intentional and proactive about creating patient demand
Philip Lederer
01:31:50
Agree with Dr Jirmanus regarding masks.
Claire Pierre
01:31:53
Truly appreciate the work you have done and thank you for bringing us together DPH and BPHC
Julia Raifman
01:32:04
Yes important for the federal government to do medication and vaccine information campaigns in many languages
Patricia McMullin
01:32:16
Would be helpful to reach out to community based organizations for advice and input
roger pasinski
01:32:21
Great presentation.
Lara Jirmanus
01:32:57
thank you for this helpful presentation!
Jonathan Pincus
01:33:17
This was very helpful. Thank you.
Leigh Simmons
01:33:48
Thank you! Excellent.
Rachel Wilson
01:33:55
Thank you so much for bringing us together, DPH and BPHC. This was excellent!
Jim Morrill
01:34:03
Thank you— it would be great to get slides / recording
Melissa Leaston
01:34:45
Thank you. This presentation was very informative and clear.
Julia Raifman
01:34:55
Thank you! Really appreciate your leadership
Patricia McMullin
01:35:13
Agree thank you!
Philip Lederer
01:35:17
A new culture of collaboration in public health, infectious disease and community based care for the most marginalized. Love it. Thanks- we can bring the coalitions to the table.