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COVID-19

Nursing homes became an elder care flashpoint during the Covid-19 pandemic, and while some of the problems were brought on by the virus, others reflect longstanding issues and a lack of regulatory oversight, industry stakeholders told members of Congress this week.

Nursing home workers, policy experts and relatives of people who died were among those who testified before the Select Subcommittee on the Coronavirus Crisis, which held a hearing on Wednesday.

Dr. David Grabowski, professor of healthcare policy at Harvard Medical School, described “dire conditions” in nursing homes in 2020. The pandemic “lifted the veil on nursing home care in America,” he said.

Grabowski shared research with the committee concluding that Covid-19 outbreaks in nursing homes were largely a function of where in the country a nursing home was located versus other specifics about the facility. 

“This does not suggest there was nothing that could have been done to prevent Covid outbreaks,” Grabowski said. “Rather, it suggests that policymakers needed to adopt a system-level approach to address this problem,” Grabowski said. 

Adelina Ramos, a certified nursing assistant at a nursing home in Rhode Island, described the conditions in the nursing home in the spring of 2020. She recounted to the committee that while working with residents who couldn’t eat, drink, get out of bed or go to the bathroom without help, and who required oxygen to be changed every 15 minutes, she had to “make impossible choices about which residents to help” because the facility was understaffed. 

Ramos is now a member of a nursing union, which she attributes to improved working conditions, including paid sick leave and better health insurance. But she said it’s up to the government to look at this struggling industry and provide oversight. 

“We want guidelines to ensure that we have safe staffing levels more often,” Ramos told the committee. 

“The majority of nursing home workers are women and people of color and we are often called unskilled and uneducated,” Ramos said. “Our jobs are devalued and it’s disgraceful that after two-and-a-half years of a daily pandemic we are still treated this way and we are fed up with the lack of respect from nursing home owners and lawmakers, so our workforce change needs to happen now.” 

Racism and structural inequities affect both staff and nursing home residents alike, according to witness Dr. Jasmine Travers, assistant professor of nursing at NYU.

She cited research showing that halls with any black residents experience significantly more Covid infections and deaths than homes with no black residents. This was a problem highlighted during the pandemic, but not created by it. 

“Beyond the pandemic when compared to their white counterparts Black or Latino residents are likelier to experience pressure ulcers falls and under treatment for pain, ordered anti-psychotics, put in restraints and are less likely to receive preventative care,” Travers said. Residents who identify as LGBTQ+ and are living with dementia often do not receive required care, Travers said, because of limited staff knowledge, training and a failure to hire staff that is “culturally congruent” to residents. 

She recalled the pungent smells that “stung” her nose when visiting nursing homes during the pandemic because the Centers for Medicare and Medicaid Services waived inspection requirements.

“I urge the subcommittee to recognize that older adults do not want to stop living, although they might need help living,” Travers said.

Several witnesses blasted the failure of former New York Gov. Andrew Cuomo to address the crisis in nursing homes, saying he was preoccupied with a book deal. One committee member, Rep. Steve Scalise, R-Louisiana, asked the witnesses for statistics on whether New York nursing homes were pressured to not follow CDC guidelines, after hearing many accounts about Cuomo’s failure to address nursing homes in the state while he was in office. 

Though none of the witnesses had statistics on hand about the direct impact of the governor’s orders on nursing homes, one New Yorker described how the virus affected his family.

Daniel Arbeeny, a Brooklyn resident, said in one week in April 2020 four of his family members died from Covid-19, including his father, uncle, and two cousins. Three were in nursing homes. Arbeeny cited guidance he received from the nursing home where his father was that said he needed to bring his father home, where it would safer there than the nursing home. He said the nursing home had been instructed by New York regulators to readmit Covid-19 positive residents to their facility even if they were unequipped. 

“It was like a hurricane. I have no other way to describe how my family came together and made a plan,” Arbeeny said, recalling when he received the news from the nursing home that his father would be safer at home. “We were in a race for our lives and we knew it,” though his father eventually died at 88 from the virus while at home a week later.

Rep. Scalise said he would find answers and statistics about directives from the New York regulators that influenced the decisions affecting those like Arbeeny and his family, and would hold to account the authorities that abandoned New York nursing homes. 

The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The foundation released a statement following the hearing saying it was “a critical step toward accountability and action to improve America’s nursing homes.”

Photo: Tempura, Getty Images

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Under new rules agreed by the National Cabinet yesterday, asymptomatic people who have tested positive for COVID will only have to isolate for five days.

However, the seven-day mandatory isolation will remain in place for people with symptoms and workers in high-risk settings like disability and aged care.

In his announcement, Prime Minister Albanese noted that these changes are a “proportionate response at this point in the pandemic” and will come into effect from Friday, 9 September.

“What we want to do is to make sure that government responds to the changed circumstances, that COVID likely is going to be around for a considerable period of time,” he added.

NSW Premier Dominic Perrotett has previously pushed for shorter isolation periods, backed by the federal opposition leader Peter Dutton. Meanwhile, Victorian Premier Daniel Andrews said he would back the move ‘if supported by health advice.’

The news of shorter isolation periods has been welcomed by business groups like the Australian Retailers Association (ARA).

“Covid and the flu are significant factors in the current staffing challenge,” said Paul Zahra, CEO, ARA. “If people are healthy, we should allow them to get back to work. We thank the Prime Minister, Premiers and Chief Ministers for taking this common sense approach, which is an important step forward in our transition towards living with Covid.”

The Australian Chamber of Commerce and Industry (ACCI) also supported the move. ACCI chief executive Andrew McKellar highlighted this will significantly reduce the burden of workforce shortages on Australian business.

“Reducing isolation rules from seven to five days for those without symptoms will be critical in further alleviating the acute workforce shortages across the economy,” Mr McKellar said.

“With businesses recording worsening staff absences, this change will enable more employees to return to work earlier, ensuring businesses can keep their doors open and keep the economy moving.”

Along with shorter isolation periods, the National Cabinet has also agreed to drop requirements to wear masks on domestic flights. This, too, will come into effect on 9 September.

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READ MORE: The Jobs and Skills Summit: What it means for SMEs

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White pharmaceutical pills spilling from prescription bottle over American map

Dr. B has raised $8 million in seed funding for its newly launched telehealth prescription service now available in 41 states. The company is named after CEO and Founder Cyrus Massoumi’s grandfather, who was nicknamed Dr. Bubba and became a doctor during the 1918 Spanish flu.

Founded at the height of Covid-19 in 2021, New York City-based Dr. B started as an online business that matched people with unused vaccines. It was able to offer vaccines to more than 1 million people in 37 states by partnering with more than 700 healthcare providers, according to a news release. Now as vaccines are more readily available, the company is switching gears. It now aims to improve the limited access to at-home Covid-19 treatments, starting with Paxlovid and molnupiravir.

“While Covid-19 antiviral pills have been available for several months and there is a lot of demand, many people still have a hard time accessing them because they require a prescription,” Massoumi said. “Patients need flexible options for getting that prescription, which is why we started by providing Covid-19 antiviral prescriptions.”

Although the company is starting with these prescriptions, the funding will help it expand to other treatments beyond Covid-19, Massoumi said. This includes treatments for heart health, dermatology and reproductive care. The startup will also work to offer its service in languages other than Spanish and English, he added.

To receive prescription medications, Dr. B patients fill out an online assessment through its website. They have to submit a photo of a positive Covid-19 test and answer questions about symptoms, pre-existing conditions and medications they’re currently taking. Then a board-certified doctor reviews the responses and if the physician finds the patient is eligible, a prescription is sent to the patient’s pharmacy of choice.

“We solve a key pain point in the process — the need to get a doctor prescription within five days of testing positive,” Massoumi said. “Our platform offers a hassle-free way to get prescriptions online, without the need for an appointment.”

The company is focused on providing low-cost — or sometimes no-cost — care to patients, said Massoumi, who previously founded Zocdoc, an online service that allows people to find and book medical appointments.

“I’m proud of the work we accomplished while I was at Zocdoc, but one of my biggest regrets is that we didn’t do enough to improve access to healthcare for everyone,” he said. “I’m trying to correct that with Dr. B.”

Most patients pay a $15 consultation fee. But people who need it can receive the services for free, as long as they qualify. These patients have to fill out a questionnaire about their monthly income to determine if they’re eligible.

Massoumi added that while the fee “is less than the average insurance copay” it still helps Dr. B to provide “no-cost care for lower-income patients.”

Other online prescription companies include GeniusRx and Amazon Pharmacy, but Massoumi said Dr. B differs from competitors by providing this no-cost option.

Photo: Stuart Ritchie, Getty Images

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The FDA has authorized Johnson & Johnson’s Covid-19 vaccine for emergency use, adding a third vaccination option—one that comes with storage and distribution advantages.

The regulatory decision followed the review of an FDA advisory panel, which voted unanimously on Friday to recommend authorization of the vaccine. J&J said it has begun shipping its vaccines to the federal government, which will manage distribution. The company expects to deliver enough vials for the vaccination of more than 20 million people in the U.S. by the end of March, ramping up to 100 million vaccinations by mid-year.

The J&J shot joins the messenger RNA vaccines developed by Moderna and partners Pfizer and BioNTech as the only authorized Covid vaccines in the U.S. The mRNA vaccines must be transported and stored at ultra-cold temperatures well below temperatures of typical medical freezer equipment. However, vaccination sites now have a little more flexibility in how they can store mRNA vaccines. Last week, the FDA approved a request from Pfizer and BioNTech to permit storage of their vaccine at pharmaceutical-grade freezers for up to two weeks.

The J&J vaccine can be transported and stored at refrigerator temperatures, making it a better option for rural areas or vaccination sites that don’t have the specialized freezer equipment required to store the mRNA vaccines. It has the additional advantage of being a single shot, unlike the mRNA vaccines that are given as two doses weeks apart. A single shot avoids the challenges of getting people to return for a second injection.

“The potential to significantly reduce the burden of severe disease, by providing an effective and well-tolerated vaccine with just one immunization, is a critical component of the global public health response,” Paul Stoffels, J&J’s chief scientific officer, said in a prepared statement. “A one-shot vaccine is considered by the World Health Organization to be the best option in pandemic settings, enhancing access, distribution and compliance.

The J&J vaccine uses a virus to fight a virus. The company’s Janssen subsidiary takes adenovirus, which causes the common cold, and engineers it so that it cannot replicate and does not cause illness. This engineered virus becomes the vehicle that transports into cells a piece of DNA from SARS-CoV-2, the novel coronavirus. Cells use that genetic material to make the spike protein found on the surface of SARS-CoV-2. Those proteins spark the immune response that leads to immunity. This vaccine technology, which J&J calls AdVac, is the basis of the company’s Ebola vaccine, which was approved by the FDA in 2019.

The FDA authorization for J&J’s Covid vaccine was based on results from a global, placebo-controlled Phase 3 study that enrolled nearly 44,000 volunteers. Those participants were followed for a median of eight weeks. The main goal of the study was to evaluate the first occurrence of moderate-to-severe Covid infection with the onset of symptoms after 14 days, and then after the 28-day mark.

Overall, the J&J vaccine was about 67% effective in preventing moderate-to-severe or critical Covid infection after two weeks. After 28 days, the vaccine was about 66% effective at preventing infection. The FDA added that the J&J vaccine was about 77% effective in preventing severe or critical illness two weeks after vaccination. After 28 days, the vaccine was 85% effective in preventing severe or critical illness.

The most common side effects reported from the studies were pain at the injection site, headaches, fatigue, muscle aches, and nausea. The FDA said these side effects were mostly mild to moderate and lasted for a day or two. J&J does not yet have enough data to determine how long protection from the vaccine lasts. The studies conducted to date also do not show whether the vaccine stops people from transmitting the virus. As part of the emergency authorization, J&J must continue to collect data about its vaccine and report and serious adverse events.

The J&J vaccine is given as a 0.5 mL intramuscular injection. The vaccine is shipped in vials, each containing five doses. The company estimates the vaccine will remain stable for two years stored at minus 4 degrees Fahrenheit (minus 20 degrees Celsius). At refrigerator temperatures in the range of 36 to 46 degrees Fahrenheit (2 to 8 degrees Celsius), the company says the vaccine can be stored for up to three months. The company will deliver the vaccine with the same cold chain currently used to ship its other medicines.

The federal government will manage the allocation and distribution of the J&J vaccine according to guidelines set by the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Johnson & Johnson said that it plans file an application seeking a formal FDA approval later this year. The company is also seeking authorizations for its vaccine in other markets.

Photo: Esben_H, Getty Images

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The U.S. is one step closer to making available another Covid-19 vaccine after a panel of experts voted unanimously Friday to recommend emergency use authorization for a shot developed by Johnson & Johnson.

The independent panel, comprised of mostly physicians, voted 22-0 to support the vaccine with no one abstaining. These votes aren’t binding on the FDA, but the agency often follows the recommendations of its panels. A decision could come as early as this weekend. The two Covid vaccines currently cleared for emergency use received their authorizations the day after their respective advisory panel meetings.

The Johnson & Johnson vaccine would offer an alternative to the ones currently available from the Pfizer and BioNtech alliance, and Moderna. Those messenger RNA vaccines must be distributed and stored at ultra-cold temperatures, then thawed before use. Those shots are given as two doses, weeks apart. The J&J vaccine can be kept at refrigerator temperatures. Another key difference is that the J&J jab requires a single shot. Together, those features will make the J&J vaccine easier to distribute to more people in more places through distribution channels that are already in place.

Panel members expressed support for the J&J vaccine, saying that the safety and efficacy data supported its authorization. But panelists also cautioned the public against picking vaccine favorites.

“It’s important that people do not think one vaccine is better than another,” said Cody Meissner, an infectious disease expert and professor of pediatrics at the Tufts University School of Medicine. “There is no preference for one vaccine over another and all vaccines work with what appears to be equal safety and equal efficacy as of this time.”

Emergency authorization is not the same as an approval. Federal law permits the FDA to allow marketing of unapproved medical products for emergency situations, such as a pandemic. Authorizations only last for the duration of the emergency. These authorizations can also be revoked if new data show that the product is not safe or effective. Stanley Perlman, a professor in the departments of microbiology and immunology at the University of Iowa, said that while the clinical studies to date have produced data about the vaccine’s safety and efficacy, it would be “nice to have more.”

The J&J vaccine may be new, but compared to the mRNA vaccines, the technology behind it has bit of a longer track record. J&J vaccine makes it using its AdVac technology, the same platform that produced the company’s Ebola vaccine, which the FDA approved in 2019. The technology takes the virus that causes the common cold and modifies it so it doesn’t cause illness. That engineered virus is the delivery vehicle that ferries into cells a snippet of genetic code for the novel coronavirus’s spike protein. The genetic material serves as the blueprint from which the body’s cells produce spike proteins. The immune system responds by producing antibodies to those proteins, conferring immunity.

The clinical data to date for J&J Covid vaccine covers 44,000 adults from all over the world. In Phase 3 data reported in late January, the vaccine was 66% effective overall in preventing moderate-to-severe infection, 28 days after vaccination. Furthermore, the vaccine showed 85% efficacy in preventing severe disease, and showed complete protection against Covid-related hospitalization and death, also measured at day 28.

Those marks look inferior to the greater than 90% efficacy demonstrated in mRNA vaccine trials. But cross-trial comparisons are difficult and can be misleading because trials have different designs and different goals. Also, the mRNA studies were conducted earlier in the year when there were fewer variants circulating. Public health experts have said that if those vaccines were tested under current conditions, their efficacy rates might be lower, too.

Plans are already underway to gather more data about J&J’s shot, including a study of the vaccine in children and teens. Johan Van Hoof, the global head of the infectious diseases and vaccines for J&J’s Janssen subsidiary, told the advisory panel that a clinical trial testing the vaccine in those 17 and younger is expected to begin this spring. He also said that the company is assessing how the vaccine responds to variants of the novel coronavirus.

Shortly after Friday’s meeting, the FDA issued a statement saying that it would “rapidly work” with J&J toward finalization and issuance of an emergency use authorization. The agency added that it has notified federal partners involved in the allocation and distribution of vaccines, so that they are ready.

Photo: Getty Images, Sezeryadigar

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health insurance, Obamacare

A rise in insurer participation in the Affordable Care Act individual marketplace indicates that payers are anticipating a fruitful year ahead. The installation of a new president and ongoing Covid-19 pandemic appear to be driving this trend.

Over the past year, insurer participation in the ACA individual marketplace has grown and benchmark premiums have declined, according to a new analysis by the Robert Wood Johnson Foundation. The total number of insurance offerings sold on the marketplace is now 9,144, which is about 75% of the 2015 record high.

This suggests that insurers are anticipating increased enrollment as a result of federal policy changes and the impact of the Covid-19 pandemic, said Katherine Hempstead, senior policy adviser at RWJF and author of the analysis, in an email.

“The Biden administration has been emphatic about its commitment to the ACA marketplace,” she said. In particular, the administration has committed to preserving and expanding health coverage to help Americans during the pandemic.

In his American Rescue Plan, President Joe Biden called on Congress to subsidize continuation health coverage through the end of September and to expand and increase the value of the Premium Tax Credit. The latter move will help lower or eliminate health insurance premiums and ensure enrollees will not pay more than 8.5% of their income for coverage.

Further, Biden recently reopened the HealthCare.gov insurance markets for three months to enable Americans to sign up for coverage amid the ongoing pandemic.

Though these policy changes are temporary, there is a commitment on the part of the administration to try to make them permanent, Hempstead said.

Drilling down into participation among major insurers, Hempstead found that Anthem, UnitedHealth and Cigna currently comprise about two-thirds of the national commercial offerings on the individual marketplace. Centene, which dominates the Medicaid managed care organizations category, made its largest single-year increase, nearly doubling its marketplace offerings from 2020 to 2021.

In addition, participation by newcomers like Oscar and Bright Health has grown steadily. Bright Health is now in 10 states, and Oscar is in 19.

Another key analysis finding is that states that have yet to expand Medicaid saw increases in insurer participation. Increased participation in the ACA individual marketplace was particularly focused in Florida, Georgia, North Carolina and Texas, where the number of offerings increased by almost 50% in the last year.

“This is where the greatest number of uninsured people live, so it is the biggest opportunity for membership growth,” Hempstead said.

Looking ahead, it is clear that insurers are hopeful that a significant expansion in healthcare coverage is due, and they see the ACA marketplace as an increasingly important part of the coverage landscape, according to the analysis.

Photo: BrianAJackson, Getty Images

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A major concern during the Covid-19 pandemic has been that Americans, especially those with underlying conditions, will delay necessary care. New survey results show this concern is not unfounded.

As of last September, about 40% of Americans with one or more chronic health conditions reported delaying or avoiding care, according to a new report from the Urban Institute and Robert Wood Johnson Foundation.

Report authors analyzed data from the second wave of the Urban Institute’s Coronavirus Tracking Survey, a nationally representative survey conducted Sept. 11-28, 2020. The survey polled 4,007 adults, ages 18 to 64 years.

About 36% of Americans said they delayed or did not receive healthcare due to a fear of exposure to the coronavirus or because a provider limited services during the pandemic, the report states. Black adults (39.7%) were more likely than white (34.3%) or Hispanic/Latinx (35.5%) adults to report delaying or forgoing care because of concerns about virus exposure.

About four in 10 adults with one or more chronic health conditions (40.7%) said they delayed or avoided care because of the pandemic, as compared with 26.4% of adults with no chronic conditions.

In addition, more than half of adults with both a physical and mental health condition (56.3%) reported delaying or avoiding healthcare due to the pandemic. About 43% of this group also reported delayed or forgoing multiple types of care.

The impacts of delaying or avoiding care were acutely felt by those with chronic conditions, the report shows. An estimated 23.2% of these adults reported that going without or delaying care worsened a health condition, 21% said it limited their ability to perform daily activities and 15.2% said it limited their ability to work.

Further, the report shows the kinds of care that Americans were avoiding. Dental care was the most common type of care adults delayed or did not receive because of the pandemic (25.3%), followed by seeing a general doctor or specialist (20.6%) and receiving preventive health screenings or medical tests (15.5%).

“Tackling unmet healthcare needs requires effectively assuaging fears about exposure to the coronavirus,” report authors concluded. Providers need to reassure patients that they are following public health guidelines and that these precautions can effectively prevent virus transmission.

“More data showing healthcare settings are not common sources of transmission and better communication with the public to promote the importance of seeking needed and routine care are also needed,” the authors wrote.

Photo: YinYang, Getty Images

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Care for chronic conditions has been severely disrupted amid the Covid-19 pandemic. To prevent further disruption, providers are increasingly partnering with IT companies.

Mount Sinai Health System and Current Health entered into one such partnership in December, with Mount Sinai implementing the company’s remote patient monitoring solution.

Their goal? To enhance care for cancer patients.

Current Health provides a wearable device to patients, which continuously monitors their vital signs, said Chris McCann, co-founder and CEO of Current Health, in a phone interview. The data is then transmitted back to the patient’s care facility. The solution alerts clinicians if the data indicate any abnormalities or potential care issues. At this point, the clinician decides whether the issue can be managed remotely or if the patient needs to be brought into the hospital.

Over the course of the Covid-19 pandemic, cancer screenings and treatment dropped drastically, which could lead to an increase in patient death rates, researchers warned.

A study published last year in JCO Clinical Cancer Informatics shows that at the peak of the pandemic in April 2020, screenings for breast, colon, prostate and lung cancer decreased significantly as compared to the same period the year prior. In addition, the number of mastectomies performed reduced consistently from April through July of last year, and colectomies similarly reduced between April and May.

“These problems, if unmitigated, will increase cancer morbidity and mortality for years to come,” the researchers wrote.

For Mount Sinai Health System, the drops in patient volume were striking. In April of last year, New York City was the global epicenter of the pandemic, and Mount Sinai, like other hospitals in the region, had to suspend elective procedures. The health system experienced a 25% decrease in volume in its ambulatory as well as inpatient settings in April, said Dr. Cardinale Smith, chief quality officer for cancer services at Mount Sinai, in a phone interview.

Even now, patient volume is 10% lower than what it was during the same time period last year, “which indicates to us that there are people who are likely staying closer to home to receive treatment,” she said.

This reluctance on the part of patients — to either risk coming into a health facility or traveling to a facility further away from them — was one of the reasons Mount Sinai looked into remote patient monitoring solutions for oncology.

The system decided to deploy Current Health’s solution, funding the implementation through a Federal Communications Commission grant. The rollout is currently in the pilot phase.

“What I’m hoping that we will see is that this gives us another way to monitor our patients and be able…to get them into a higher level of care when needed, and otherwise be able to really treat them in place so that they feel both safe and comfortable,” Smith said. “And also, so that we don’t overwhelm a healthcare system that is already being overwhelmed.”

Another reason for implementing the remote monitoring system was the growing digital divide among patients.

Mount Sinai clinicians saw that some of their patients, including people of color and the elderly, were less likely to use telehealth services, said Smith.

Smith hopes that the solution will help them care for those patients since Current Health provides the wearable devices and tablets that the patients need. The patients are trained on the devices, which are easy to use — even for the less-than-savvy tech user, Smith said.

Similarly, the health system educated and trained their clinicians on the new solution. As it is a novel mode of cancer care delivery, they needed to make sure they answered all their clinicians’ questions and concerns, she said.

The demand for remote monitoring solutions has exploded during the pandemic. Current Health, which received Food and Drug Administration clearance for its solution at the end of 2019, soon saw an explosion in demand, McCann said. The company experienced a 400% expansion of its customer base. This includes the addition of hospital customers like Mount Sinai Health System and Boston-based Massachusetts General Hospital.

“What [remote patient monitoring] does is it expands the criteria of patients who can actually be managed at home versus within a hospital and that has been a huge asset to us as a company — particularly in the [current] moment,” McCann said.

Photo: chombosan, Getty Images

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Metoprolol (muh•tow•pruh•laal). Eszopiclone (es•zoe•pik•lone). Hydrochlorothiazide (hy•dro•klor•oh•thi•a•zide). Amitriptyline (a•muh•trip•tuh•leen). Canagliflozin (kan•a•gli•floe•zin).

Are you able to recognize or pronounce any of these commonly prescribed medications? If so, you might be a pharmacist, or at least have experience providing patient care. It’s fair to say that most people find it challenging to pronounce drug names, and it may be even more challenging for the elderly.

It’s not uncommon for elderly patients to be prescribed multiple medications to treat multiple chronic conditions, and sometimes these medications come from multiple providers. In my experience, I have seen many patients fail to understand what, why and how to take their prescriptions. Some have the help of family or caregivers while others may not, which makes it even more challenging to manage. Many factors can contribute to these challenges including vision problems, memory loss, swallowing problems and or hearing loss. Medications can be extremely helpful in treating and preventing disease, or they can cause a major health setback if not taken appropriately.

As a pharmacist by training, or “pharmist” as my Grandpa likes to call me, I spend my time reviewing his medications when I’m in town to visit. He loves to sit down with me and tell me all about the medications he’s taking and what he takes them for.  At 87 years old, he’s impressively taking only three (3) medications. Up until last year, he was taking only taking one (1). He’s incredibly sharp and has never needed any extra assistance. My Grandpa is the perfect patient. He’s highly adherent and takes his medications every day, at the same time, right before his morning coffee. I understand the importance of adherence and adherence to the right medications, but I have never personally experienced or witnessed the challenges that come with adherence following discharge from a hospital stay, until now.

Covid-19 hit close to home and affected both of my grandparents this past Thanksgiving. After a few days, it was apparent they were unable to weather this virus alone. It severely affected their cognitive status and caused weakness so severe they were unable to stand or walk on their own. While staying with them during this time, a decision was made to take my Grandpa to the E.R., which led to a six-day hospital stay. Because I know he visits multiple providers and pharmacies, I knew the hospital wouldn’t have a complete record of all the medications he takes….and I was right.  I made sure he went with an updated med-list so that the doctors could give him his regular medications while in the hospital.  I knew this med-list would likely change following his discharge.

Upon discharge, I was provided with a long list of instructions from multiple people on the care team that was difficult to follow along even for me. First came a call from the nurse,  then a call from the provider, then a call from the pharmacist, and lastly a call from the company who would be dropping off his home oxygen. The pharmacist’s call was helpful, but not appropriately timed — I had no discharge papers to reference.  The provider called again, to go over the medications with us. The review was fast. Medications were discontinued. Medications were added. Some medications were named in their brand name while others were listed generically.

Who could possibly follow along? No one expressed to us the duration of these medications. When could they be stopped? Will they ever be stopped? Were refills needed, what doctor would continue to prescribe them? What if I had not been around to help?

Following my Grandpa’s return, I immediately sat down to review and organize all of his medications, new and old. One medication was discontinued, while 4 were added. My Grandpa went from taking 3 medications to 7 overnight, and each medication came with its own set of directions:

  1. Take this tablet with food.
  2. Take this tablet on an empty stomach.
  3. Take this tablet every day and skip on Saturdays.
  4. Take this tablet on Monday, Wednesday, and Friday.
  5. Skip this tablet for two days. Restart on Sunday.
    1. 2 days later* “Actually, take this medication every other day starting Tuesday.”
  6. Take this tablet every day.
  7. Take this tablet three times a day and make sure not to eat too much sugar or salt with this med.

With all of this information, I created a “Fridge Report” for when I’m not around. A Fridge Report is a simple and easy to read medication list. It displays all medications a patient is taking and how to take them in a nice visual display that is easy to follow. I also called and spoke with his primary care provider (PCP) and cardiologist to confirm his active medications and to notify them of the newly added and discontinued medications. I can’t imagine my grandparents, or anyone else’s grandparents, managing this without the help of a pharmacist. The Fridge Report was highly appreciated by my family.

“We need that (Fridge Report). It’s very detailed. No mixing up or second-guessing of medications. Now I know what to give and when to give it.” – Lorraine Armenta, My Aunt

According to the World Health Organization (WHO), care transitions threaten patient safety as they can increase the possibility of losing critical clinical information and require an increased degree of coordination. I believe a multifaceted approach is needed to improve care transitions and is especially needed for vulnerable and high-risk individuals. The transition between inpatient and community settings, in particular, is prone to medication errors related to a lack of communication between health care providers, missed patient follow-up, inadequate patient education, incomplete medication reconciliation, and the absence of patient involvement in medication management. Pharmacists can and should take a more active role in improving medication safety during care transitions; this could lead to a reduction in hospital readmissions and improved quality of care.

Pharmacists serve as quarterbacks of a patient’s at-home-care team, providing essential help to those who are taking multiple medications. We are medication safety experts and have access to sophisticated and innovative tools to better manage the medication-related needs of patients and mitigate adverse drug events (ADEs). Ultimately, engaging with your local pharmacist can reduce the burden placed on a patient’s family and the primary caregiver, while making the transition to at-home care manageable.  

Photo: JohnnyGreig, Getty Images

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As the Covid-19 pandemic continues to rage across the U.S., the Biden Administration faces a big task ahead, starting with its goal of vaccinating 100 million people in its first 100 days. Currently, just 19 million people have received their first dose, according to the Centers for Disease Control and Prevention.

A growing list of companies, including Walmart and Amazon, are lining up to help with that effort. They also hope to that their employees will be able to get their shot soon, though state plans vary widely on when essential workers can start receiving vaccines.

Walmart, which has more than 5,000 pharmacies across the U.S., has started administering vaccines in 10 states and Puerto Rico. Dr. Cheryl Pegus, Walmart’s executive vice president of health and wellness, wrote in a blog post that it had been preparing by staffing up and building a digital scheduling tool.

“At full capacity, we expect we will be able to deliver 10-13 million doses per month when supply and allocations allow,” she wrote.

She also said the company would “stand ready” to help vaccinate people in healthcare deserts and underserved communities, through partnerships with churches, youth centers and stadiums.

Amazon, which recently opened a pop-up vaccine clinic at its headquarters in Seattle, sent a letter to President Joe Biden on Wednesday offering to help with U.S. vaccine efforts, Reuters first reported.

“We are prepared to move quickly once vaccines are available. Additionally, we are prepared to leverage our operations, information technology, and communications capabilities and expertise to assist your administration’s vaccination efforts,” Dave Clark, Amazon’s CEO of worldwide consumer business, wrote in a copy of the letter obtained by MedCity News.

The company is working with Virginia Mason Medical Center to administer vaccines to the public. Amazon is providing equipment, staffing and supplies, and Virginia Mason is handling appointment scheduling and following-up with patients for their second dose, company spokesman Glenn Kuper wrote in an email.

Washington state has also tapped Starbucks, Costco, Microsoft and a cadre of other businesses to help with the logistics of distributing a vaccine.

Janet Baseman, the University of Washington’s associate dean for public health practice, said there are some things companies can do to help speed up distribution, such as managing queues of people and registration systems.

“That, for Covid testing, has been super uneven across the country. In some places, they have electronic registration systems, they say come at this time, and you’re in and out after six minutes. There are other places where you’re waiting for hours in a queue of cars,” she said. “I really think this could be a great example of a public-private partnership if everybody is able to get together to collaborate.”

When will they get vaccinated?

These retailers are also keeping a close eye to when their employees will be able to get vaccinated. Each state has different plans for when people who work in grocery stores, warehouses, public transportation and other essential jobs will get vaccinated, and it’s hard to say exactly when it will happen.

The lack of consistency across state lines has made things especially challenging for national or international companies, said Nadina Rosier, general manager of pharmaceutical solutions at the Health Transformation Alliance, a cooperative of self-insured companies.

There’s so much gray …  in understanding the administration of the vaccine and where we are in the timeline,” she said in a phone interview. “You have a number of challenging factors that are affecting employers. There isn’t a consistent definition of what an essential worker is.”

For instance, it’s easier to define whether someone is 75 or older or is at high risk than if they are an essential worker, she said. This leaves companies jockeying for a place in line, including groups like the Consumer Brands Association, the lobbying group for many of the packaged goods found in grocery stores, and ride-sharing companies Uber and Lyft, which are offering free rides to vaccine appointments while also seeking early doses for their drivers.

 In his letter to Biden, Amazon’s Clark also emphasized that many of the company’s 800,000 employees cannot work from home.

It seems unlikely that businesses will require all of their employees to get vaccinated, Rosier said, because of regulatory concerns around issuing any kind of mandate. But they can play a role in letting employees know when they’re eligible and reminding them to get their second dose.

Pegus said Walmart would strongly encourage its employees to get vaccinated, but is not mandating it or providing incentives, as some other retailers plan to do.

Vaccinating 100 million people will be a huge undertaking, though not impossible.

“I keep thinking that even though it is an unprecedented undertaking for the country, that the federal government does know how to do this. There is a playbook for this,” she said. “These are things that have been workshopped and thought about for years.”

Going forward, she expects to see a push from the federal government to increase vaccine supply and help states and local jurisdictions stand up vaccination sites across the country.

“I’m pretty optimistic that if we can get enough supply, the distribution, communication and coordination pieces can be tackled and improved substantially,” she said.

Photo Credit: RLT_Images, Getty Images

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