provider to rely on the patient’s self-reported
health history and current medication use
(which very likely could be from multiple
competing pharmacies) unknown to the
allied provider. Patients mean well, but they
are often incomplete in their self-reporting.
It is all well and good to expand access to
care right up until the point where that care
expansion could harm patients.
Advocates for Test-to-Treat and other
initiatives will argue that a medical director
or some other physician is ensuring that the
nurse practitioners and physician assistants
in the clinics are performing appropriate
care. And this may very well be true in some
“Care provided in a vacuum
is by defi nition neither
patient-centered nor
comprehensive.”
Refrences:
1. https:/www.cvshealth.com/our-services/healthand
wellness-services/minuteclinic
2. https:/www.yalemedicine.org/news/12-things-toknow
paxlovid-covid-19
the patient and ensuring that their role as
the head of the team is a cornerstone to
any care that is delivered. If physicians have
strong relationships with their allied team
members, then there are existing mechanisms,
such as delegation under protocol,
that exist to allow the patient to be seen
outside the doctor’s offi ce. But those care
delivery situations are developed out of
trust and respect for the care team, not by
allied groups taking stabs at unilateral scope
expansion.
With programs like the Test-to-Treat initiative,
it is concerning that non-physicians
would be seeing the patient and prescribing
COVID-19 therapies without the benefi t of
having a patient’s complete medical record,
including a history and existing or prior
health conditions. PAXLOVIDTM is a good example
where a practitioner needs to have a
complete picture of the patient’s health status
due to the risk of medication interactions.
In an online interview with Yale Medicine, Jeffrey
Topal, MD, stated, “There is a long list of
medications Paxlovid may interact with, and
in some cases, doctors may not prescribe
Paxlovid, because these interactions may
cause serious complications. The list of drugs
that Paxlovid interacts with includes some
organ anti-rejection drugs that transplant
patients take, as well as more common drugs
like some used to treat heart arrhythmias.”
Paxlovid also decreases the metabolism of
anticoagulants, or blood thinners, that many
older adults depend on, driving up levels of
those medications in the body to a point
where they are unsafe, Dr. Topal explains.
Almost across the board, pharmacy clinics
are not connected to physician electronic
health records, which leaves the prescribing
cases. The concern is that taking the primary
care delivery outside the physician’s offi ce
and placing it with an unassociated allied
health provider carves the primary care
physician (PCP) out of the patient’s overall
care plan. In my reading of the program,
there is not even a requirement for the allied
professional to attempt to gather information
about who the patient’s primary
physician is, nor to communicate the services
provided back to that physician. It seems
like a serious defi ciency in the care plan not
to require that a pharmacy provider notify a
patient’s PCP that the patient tested positive
for COVID-19 and was provided antiviral
medications.
Finally, for those who argue that not all
patients have a PCP care home and these
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types of programs are the only means of
receiving care outside the emergency room,
that is indeed true. We should remain aware
that not everyone has the benefi t of calling
up their doctor and scheduling a visit, and
be compassionate toward those in such
situations. But the Test-to-Treat initiative also
includes access points such as community
health clinics, which are systems of care that
are integrated to overall care and should
be places where uninsured, underinsured,
or other underserved patients can be seen.
Care provided in a vacuum is by defi nition
neither patient-centered nor comprehensive.
Innovation is often messy. And in many instances
that innovation allows room for trial
and error with calculated consequences. But
in health care settings where patients’ wellbeing
is on the line, we simply must do better
to perfect our approaches before trying the
next great idea. DMJ
Jon R. Roth, MS, CAE
DCMS EVP/CEO
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