The demands of the news cycle might not be the first thing that comes to mind when you think about the countless decisions a hospital must make for patient care.

Yet, when the U.S. Food and Drug Administration gave Paxlovid the green light for emergency use as a COVID-19 treatment, the news cycle played an oversized role in the drug’s roll-out, say care leaders at association member Hennepin Healthcare, in Minneapolis.

“The information hits the evening news at the same time, or before, it gets to health care organizations, so there is a constant struggle for how to have a system, particularly a smaller one, ready to respond in some way by the end of the 5 o’clock news,” explains Kate Hust, MD, MPH, who serves as medical director of ambulatory quality and the Clinic & Specialty Center Internal Medicine Clinic at Hennepin.

Timing like that can prompt patient requests for a drug before the health care system can stock it, Hust says. She added that Minnesota presents a particular challenge, as a state-led infrastructure for managing the equitable distribution of treatments, such as Paxlovid, can lengthen set-up time.

To ensure access to Paxlovid, Hennepin mobilized its medication courier service that delivers Paxlovid to local patients at no cost. For patients who find themselves in quarantine without friends or family available to pick up their medications, or at-risk patients who simply can’t go out and get the medication, at-home delivery is the only way of accessing the life-saving drug.

A Hennepin pharmacy technician and pharmacist work together to get a patient’s medications ready for delivery. Photo courtesy of Hennepin Healthcare.

Prior to the pandemic, Hennepin’s courier service was used infrequently, Hust explains, but it “became a more robust option during the pandemic, just because people couldn’t, wouldn’t, didn’t otherwise connect to their medications in some cases.”

Hennepin staff also found great benefit in outreach calls to patients awaiting COVID-19 test results or who had tested positive to make them aware of the Paxlovid option and address other concerns about COVID-19.

Mark Holtan, PharmD, clinical ambulatory manager and specialty pharmacy manager at Hennepin, notes that patients valued the personal phone calls from pharmacists, which established a greater level of trust.

“The clinical component of this work is significant, but the emotional impact of this outreach should not be discounted,” Holtan explains.

Many patients diagnosed with COVID-19 were so concerned about accessing and affording Paxlovid that they struggled to listen to their provider’s guidance on the call.

“I flipped the script. I went from the very beginning and said, ‘By the way, this is going to be no cost to you, and we will deliver it to you.’ You could hear an exhale amongst the COVID coughs, the relief, and they would truly listen,” says Holtan.

The outreach calls and courier service have helped increase Paxlovid uptake among COVID-19 patients, Hust says.

“Since I’ve started doing the outreach calls, we haven’t had patients decline Paxlovid because of access,” Hust says. “It definitely has helped with the uptake of Paxlovid, being able to get it right to their door, if needed.”

Outreach calls also proved beneficial in facilitating Paxlovid education and guidance across different cultural communities in the greater Minneapolis area.

“Members of various racial and ethnic communities in the Twin Cities had grapevine family members, community members, and friends express concern that they weren’t sure how to access it,” says Hust. “We did do some look-backs to make sure that we had things set, that we had a system by which people could call and access medication.”

Hust credits the health system’s smooth outreach to non–English speaking patients, for example, to the resources Hennepin long has offered.

“We have a very robust system already in place for things like language services, whether that’s in-person or phone-based interpreters for clinical activities that help in various steps of the way. That’s one thing that immediately helped with some of those barriers,” she explains.

Preventing possible drug interactions between Paxlovid and other medications has been a major concern for Hust and other prescribers.

A Hennepin pharmacist prepares a patient’s medications to go out for delivery. Photo courtesy of Hennepin Healthcare.

“There is simply a good chunk of work that needs to happen to safely prescribe meds, especially Paxlovid, which has oodles of drug-drug interactions with common medications for those who qualify for the treatments,” she explains.

Holtan found that asking patients awaiting COVID-19 test results up front if they’d be interested in receiving Paxlovid treatment in the case of a positive test helped prescribers get ahead and immediately begin evaluating possible interactions.

In response to these and other concerns, the team also developed a toolkit for pharmacists with guidance on navigating complex patient situations and creatively developing a plan for dispensing medications.

Holtan says the key to ensuring quality Paxlovid education and distribution is “…not just being reactionary, but being proactive,” adding that major Minnesota health systems mobilized to share information and ideas to develop processes that meet their patient populations’ unique needs.

“We continue to adapt our processes by working with different disciplines within our health care system and sharing workflows with outside systems, with a goal of being able to turn up the dial if needed on our efforts,” he says.