Source/Disclosures
Disclosures:
McGarry reports receiving grants from the National Institute on Aging and Agency for Healthcare Research and Quality, and consulting fees from AARP. Please see the study for all other authors’ relevant financial disclosures.
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Key takeaways:
- Nursing home facilities with more non-white and Medicaid residents were less likely to administer antivirals to patients with COVID-19.
- More than 40% of nursing homes reported never administering antivirals.
Despite being at greater risk for adverse COVID-19 outcomes, just one in four nursing home residents with COVID-19 received antiviral treatment from May 31, 2021, through the end of 2022, researchers found.
Brian E McGarry, PT, PhD, an assistant professor in the department of medicine at the University of Rochester Medical Center, and colleagues wrote in JAMA Network Open that nursing homes residents are a priority for antiviral treatment for COVID-19 because of their high risk for severe infection.
More than 40% of nursing homes reported never administering antivirals. Image: Adobe Stock.
“Although oral antiviral use has been found to be greater in nursing homes than the community, overall use among nursing home residents has been low and may not be commensurate with residents’ elevated risk,” the researchers wrote.
They added that there are several barriers to administering antiviral treatment in nursing homes, “including treatment access, frequently changing authorizations and recommendations on the use of monoclonal antibodies, patient and physician preferences, unfamiliarity with these medications, and treatment costs.”
Using data from the CDC’s National Healthcare Safety Network Nursing Home COVID-19 database, McGarry and colleagues evaluated COVID-19 treatment rate trends in nursing homes from May 31, 2021, to Dec. 25, 2022.
During the study period, there were 763,340 resident cases of COVID-19 across 15,092 nursing homes, with 136,066 residents being treated for COVID-19.
The overall antiviral treatment rate was 17.8% (95% CI, 17.4-18.3) throughout the study period. The mean rate increased to 24.5% (95% CI, 23.2-25.7) during the final 6 weeks. The moving average treatment rate peaked at 32.7% (95% CI, 30.5-34.8) on Nov. 21, 2021.
The researchers noted that 61.1% of treatments in 2022 consisted of Paxlovid (nirmatrelvir-ritonavir, Pfizer) and 18.2% consisted of Lagevrio (molnupiravir, Merck).
There was a steady increase in the percentage of nursing homes that had ever administered antivirals for COVID-19; however, McGarry and colleagues found that 41% still reported no use by the end of 2022.
Several factors were linked to greater chances of antiviral use by facilities, which included:
- larger bed sizes;
- higher overall quality ratings;
- to an affiliated geriatrician;
- higher resident and staff vaccination rates; other
- greater mean resident age and acuity.
In contrast, facilities with for-profit aspects and those with higher shares of Medicaid and non-white residents were less likely to use antivirals.
The study was limited by its observational design that prevented casual interpretation by the researchers. Additionally, treatment eligibility at the resident level could not be determined.
McGarry and colleagues concluded “that structural barriers may be contributing to underuse and disparities” in COVID-19 antiviral treatment in nursing homes.
References:
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