At-risk COVID patients in WA directed to GPs for antiviral access

GPs in Western Australia have been made central to the prescribing pathway for access to COVID-19 antiviral treatments.
 
The change, implemented by WA Health, means patients enrolled in the State Government’s COVID Care at Home (CC@H) program and deemed potentially suitable for antiviral treatment will be referred to their GP or non-GP specialist for further assessment.

CC@H is for COVID positive patients deemed high risk due to identified medical or social risk factors and symptoms.
 
Previously, patient assessments would be conducted by the program’s infectious disease physicians, with referrals completed and approved in the hospital setting.
 
However, WA Health has since noted in a letter issued to GPs that original process was ‘inefficient’.
 
‘There are several antiviral treatments available, all with different indications and contraindications,’ the letter reads.
 
‘Given this, it is most appropriate that a practitioner who knows the patient and has access to their medical records considers these factors and determines the patient’s suitability and the preferred therapy.’
 
GPs were only made aware of the referral pathway change three days prior to it coming into effect on Monday 21 March.
 
To ensure clinicians would have enough time to prepare, the RACGP’s WA Faculty, together with WA Primary Health Alliance (WAPHA) and the AMA’s WA branch, issued a joint request to the State Government to delay the pathway’s implementation.
 
Chair of RACGP WA, Dr Ramya Raman, who is in ongoing discussions with the State Government, told newsGP the college is acutely aware that GPs had been given little time to adequately prepare for the change.
 
‘We wanted to ensure that GPs had adequate information and had time to actually process this, including understanding the antiviral medications and the actual process of working through the criteria for using these medications,’ Dr Raman said
 
Molnupiravir (sold as Lagrevio) is currently the only antiviral for COVID-19 available through the Pharmaceutical Benefits Scheme.
 
It can also be sourced through the National Medical Stockpile (NMS) alongside nirmatrelvir plus ritonavir (sold as Paxlovid) and sotrovimab, but this access is subject to WA Health access criteria, specialist approval (via an approval form) and a ‘tiered prioritisation’ system.
 
‘The complexity of understanding the use of these medications and assessing a patient for suitability and prescribing takes time,’ Dr Raman said.
 
‘And general practice is already quite busy; we are really pulling together to make sure our community and patients are safe.’
 
As outlined by WA Health, symptomatic patients with mild disease who have underlying factors that may put them at greater risk for severe infection will be directed to either their GP, or non-GP specialist.
 
‘An accompanying letter outlining the referral request, with clear instructions for the patient will be provided,’ they said.
 
‘Where possible, CC@H will call the practice to alert them to the referral.’
 
However, according to guidance from the National COVID-19 Clinical Evidence Taskforce, all three antivirals are recommended for use within five days of symptom onset to be effective.
 
Dr Raman said this means ‘time is of the essence’, which raises concerns for patients whose general practice may not be operational on weekends.
 
‘We are in discussions with WA Health and have really emphasised and explained these concerns, which are clinical concerns that we hold,’ she said.
 
‘They have offered more dialogue to understand, and are also offering an alternate pathway so that patients can be directed to WA Health via the infectious diseases physicians if the GP or the general practice is unable to do this in a reasonable timeframe.’
 
In addition to ongoing talks with the state’s health department, the WA Faculty has also been working closely with WAPHA to have the health pathways guideline reviewed. WA-based GPs can also access the latest guidance through the RACGP’s COVID resources webpage, and through the state faculty’s Facebook group.
 
‘And we are also planning a webinar next week to be able to discuss the antivirals,’ Dr Raman said.
 
In the meantime, Dr Raman said the college is also working closely with the State Government to streamline the referral process.
 
‘They are open to the idea that we need to actually go through this process and simplify it, and make it as clear as possible for GPs and not too time onerous,’ she said.
 
‘We have also emphasised the need for access to clinical advice from the infectious diseases physicians.
 
‘WA Health has indicated that if doctors call the major tertiary centres here in WA and ask for the COVID consultant on-call, they should be able to get clinical advice, as well as the process advice that may be required.
 
‘That’s a very important support for our GPs.’
 
GPs are being advised to familiarise themselves with information in the following three documents, which outline further details of the changes:

• Letter to GP Specialist
• COVID-19 Medication Resources for GPs
• Letter COVID GP Treatment Letter – sample letter provided to patient by CC@H

antivirals COVID Care at Home program COVID-19 treatments WA