Public Health Emergency - Leading a Nation Prepared
This document includes promising practices and recommendations from the state of Michigan’s success in connecting patients with COVID-19 monoclonal antibody treatments. These findings are designed to provide inspiration and information to those working to build treatment awareness and demand within a primary-care setting. The information below can supplement individual plans and provide context to playbooks and planning discussions with leadership.
A second and third surge of COVID-19 cases in Michigan drove state government officials and healthcare providers to find innovative ways to encourage physicians to ensure patients had access to monoclonal antibody treatments. Michigan was able to significantly increase monoclonal antibody use during a major surge this past spring through
vocal, proactive support from the Governor and Chief Medical Executive; mobilizing paramedics, nurses, and pharmacists; establishing reporting and performance metrics; and repurposing existing case investigation software to connect patients with infusion sites.
Michigan faced particularly high COVID-19 infection rates in long-term care facilities, as well as dangerous surges – and access issues – in both densely populated areas (such as metropolitan Detroit) and rural regions. At the same time, provider hesitancy to prescribe monoclonal antibody treatments delayed uptake of the state’s designated supply. Michigan’s approach to connect patients with monoclonal antibody treatments and support healthcare providers leveraged the following factors:
The following section provides key recommendations based on Michigan’s experience.
Repurposing Existing Tools with New Purpose for More Efficient Contact Tracing
Michigan repurposed an existing public health tool for case investigations—the Patient Education Genius (PEG)—to send monoclonal antibody treatment information via Short Message Service (SMS) text message to people who tested positive for COVID-19.
Thousands of patients who tested positive for COVID-19 received a direct text message with a hyperlink that provided resources, including information on monoclonal antibody treatments.
To complement these efforts, Michigan deployed
state-contracted investigators for surge capacity case investigations to conduct “screening” for monoclonal antibody treatment eligibility. They used scripted messages about who was at high risk and provided direct patient messaging.
These personnel identified people at risk and made them more likely to be receptive to information and treatment in a timely manner.
While vaccination expansion efforts remain a priority, Michigan continues to actively promote monoclonal antibody therapy to both healthcare providers and the public. When case numbers are low, it is important that this therapy continues to be made available to qualifying patients. In the event of a subsequent surge, there must be processes in place to rapidly expand monoclonal antibody delivery capabilities to meet increased need and to help mitigate hospitalizations and reduce deaths. Efforts include:
The recommendations in this Promising Practices document provide a foundation for other states to connect patients to treatment for COVID-19. These recommendations could be adapted in a variety of practice settings, and at the state or county level to ensure an efficient process for connecting eligible patients with monoclonal antibody treatment.
Expanded Paramedic Scope of Practice; Maximized Personnel Available to Deliver Monoclonal Antibody Treatments
Michigan expanded the scope of practice rules for EMS personnel. Paramedics, together with state-contracted nurses, were mobilized to help long-term care facilities in seven counties that were experiencing outbreaks. This new capacity was then marketed directly to the primary care providers to complement the hospital-based capacity.
EMTs provided paratransit or ambulance transport to infusion clinics. Paramedics often started IVs for skilled nursing facilities and ran infusions.* Paramedics worked with state long-term care Mobile Crisis Teams.*
Adding paramedics to the provider pool broadened capacity and enabled targeting areas of high need.
The state plans to leverage this resource for any future cluster outbreaks, especially in areas with a low vaccination rate.
*Authorized under emergency protocols
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