The goal of this cluster randomized trial is to compare two modes of management --pharmacist care vs. pooled adult and family medicine physician care -- for electronicallysubmitted requests (e-visits) for Paxlovid by adults with COVID-19. It will comparequality of care based on counseling for common potential drug-drug interactions and timeto prescription, as well as the time and financial costs of care in the two groups.
Importance. Enhancing the management of messages from patients and providing virtual
options for urgent care are top priorities for The Permanente Medical Group (TPMG) and
Kaiser Foundation Hospitals/Health Plan (KFH/P).
Objective. To compare pharmacist management of e-visit requests for Paxlovid for COVID-19
with management by adult and family medicine physician pools regarding costs, time,
clinical outcomes, and patient and clinician satisfaction.
Design, setting, and participants. This cluster randomized clinical trial will include
adults from 17 medical facilities of Kaiser Permanente Northern California who make
Paxlovid e-visits on weekdays from October 9 to December 11, 2023.
Intervention. In the intervention group, a regional team of pharmacists will manage
Paxlovid e-visits following a standard protocol; in the comparison group, adult and
family medicine physicians (AFMs) will manage these visits according to medical
center-based protocols.
Main Outcomes and Measures. The primary outcome is whether a patient with one or more
common drug-drug interactions received counseling for any drug-drug interaction.
Secondary outcomes are the hours from the e-visit request to the prescription among
patients who receive one and the clinician time and cost per visit managed.
Potential Results. We will test the hypotheses that Pharmacist Care compared with AFM
Pool Care will have higher quality of care and lower costs based on the receipt of
counseling for common drug-drug interactions, faster time to prescriptions, and lower
clinician time and cost per visit managed.
Potential Conclusions and Relevance. If pharmacist management has better or similar
outcomes compared with AFM pool management, this will provide support to continue this
practice for Paxlovid e-visits and to evaluate possible expansion of pharmacist
management for similar clinical situations.
Other: Pharmacist Care
Management of Paxlovid e-visits per regional protocol
Other: AFM Pool Care
Management of Paxlovid e-visits per regional and local protocols
Inclusion Criteria:
- Patients making Paxlovid e-visits on weekdays from 8:00 am to 4:30 pm during the
study period
Exclusion Criteria:
- None
Kaiser Permanente Northern California
Oakland 5378538, California 5332921, United States
Tracy Lieu, MD, Principal Investigator
Kaiser Permanente