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Text reminders mooted for at-risk COVID-19 patients


Jolyon Attwooll


23/06/2022 3:01:00 PM

The Federal Health Minister has asked department officials for advice on ways of further raising awareness of oral antiviral treatments.

Man on mobile phone.
Text messages are being considered as part of a move to raise awareness of COVID-19 treatments.

Text messages could be sent to at-risk COVID-19 patients reminding them to speak to GPs about possible oral antiviral treatments to prevent severe disease.
 
That is one of the ideas being considered by the Department of Health (DoH) as authorities look for ways to ease the strain on acute care services around the country.
 
The possibility was reported in The Australian newspaper on Thursday, and a spokesperson for Federal Minister for Health and Aged Care Mark Butler has confirmed to newsGP that he is seeking advice from the DoH on the matter.
 
For RACGP Vice-President Dr Bruce Willett, the idea has merit, although he stresses that any communication would need to be carefully targeted.
 
Two oral COVID-19 antiviral treatments are currently available on the Pharmaceutical Benefits Scheme (PBS). Molnupiravir (sold as Lagevrio) was added to the PBS in March, while nirmatrelvir in combination with ritanovir (sold as Paxlovid), came online in May.
 
Prior to their addition to the PBS, they had largely only been available through the National Medical Stockpile. Both treatments are recommended for at-risk patients within five days of symptom onset.
 
Dr Willett believes there is a lack of awareness about the treatments, as well as some common misconceptions about their use that he thinks need to be addressed.
 
‘There’s some confusion out there in the community about the availability of these treatments and the recommendations for them,’ he told newsGP.
 
‘One of the issues with the antivirals is that there has been an idea that they’re there to treat severe disease, whereas of course they’re there to prevent severe disease.
 
‘They need to be taken early before people get severe symptoms … [increasing] knowledge about that would be really important.’
 
He also says any communication to patients should prompt a discussion of treatment options beyond the oral antivirals – and that it should be ‘a push not a pull’.
 
‘[Text messages] should be sent to the patient to seek advice from the GP … rather than putting GPs in a position where they have to try and chase people, which is going to be difficult,’ he said.
 
The need for prompt prescription of oral antivirals for eligible patients after symptom onset was also a theme at the weekly primary care COVID-19 response webinar on Thursday.
 
Deputy Chief Medical Officer Professor Michael Kidd said more than 55,250 people have had prescriptions through the PBS for molnupiravir, and nirmatrelvir with ritanovir.
 
More than 8000 of those have been written for residents of aged care facilities, Professor Kidd said, while more than 26,000 were for people aged 75 years and above, and more than 5000 for patients identifying as Aboriginal or Torres Strait Islander.
 
‘We are keen to see as many people as possible get access to these treatments,’ he said.
 
Professor Kidd also emphasised the importance of ensuring rapid diagnosis and urged GPs to encourage symptomatic at-risk patients to get a PCR test, even if rapid antigen tests show a negative result.
 
‘If they have symptoms, and they have a negative RAT, please ask for them to arrange to get a PCR test so that there is no delay in making the diagnosis and getting people onto treatment,’ he said.
 
Recent studies about the efficacy of the oral antiviral treatments have indicated they have most impact when administered to more vulnerable, elderly patients, with more limited results for the broader population.
 
This week, the Federal Government also announced an $11 million campaign to improve booster vaccination rates, as well as awareness of the oral antiviral treatments.
 
Dr Willett believes the initiative is a timely one.
 
‘I think everyone has got a bit COVID overdosed and is kind of tuning out when the media and doctors talk about COVID,’ he said.
 
‘Knowledge of these agents has been lost and there is not particularly good awareness, so I absolutely welcome a campaign to create awareness.’
 
He shares the view that prompt prescribing of the treatments to the right people could help ease the pressure on a stressed health system.
 
‘The hospital system is really in danger of being overwhelmed by the coincidence of COVID and influenza pandemic and epidemic occurring at the same time,’ Dr Willett said.
 
‘Certainly if people are getting the antivirals, it has the ability to alleviate suffering [and] also the strain on the hospitals.’
 
Who is eligible for oral antivirals in Australia?
According to PBS criteria, the drugs can be prescribed for those with mild-to-moderate COVID-19 confirmed by a PCR or rapid antigen test within five days of symptom onset, among the following patient groups: 
 

  • Those aged 65 or older, with two other risk factors for severe disease
  • Those aged 75 or older with one other risk factor
  • Those aged 50 and older who are of Aboriginal or Torres Strait Islander origin with two further risk factors for severe disease
  • Those with moderate-to-severe immunocompromise
 
The RACGP’s COVID-19 resources includes information relevant for every state and territory.
 
A guide with details relevant to general practice about the COVID-19 oral antivirals has also been published by newsGP.
 
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Dr Arshad Hussain Merchant   24/06/2022 6:46:46 AM

It would be far easier to send patients electronic scripts rather text reminders for eligible patient
This will reduce pressure on primary care where every other problem has been dumped


Dr D. Stewart   24/06/2022 1:56:52 PM

It is completely confusing that the National Covid-19 Clinical Evidence Taskforce guidelines still state that “the efficacy of molnupiravir in vaccinated individuals is not known” and they recommend use of it and Paxlovid ONLY IN UNVACCINATED INDIVIDUALS. This is different to the PBS criteria and is confusing for GPs.


Dr Nino Scuderi   26/06/2022 11:06:39 AM

Using state developed guidelines on managing COVID patients in primary care, I assessed and satisfied criteria for two patients and prescribed antivirals. We then found that both patients were not able to access the medications at their local pharmacy. Instead both pts were instructed by their pharmacist to attend the local public hospital to get scripts filled. A call to the local public hospital pharmacy, informed me that unless the patients were admitted to the hospital Virtual Covid Ward they would not be provided any antivirals. So I arranged admission to the virtual covid ward only to find out 24 hours later that both patients were assessed by infectious disease registrar and both patients were ineligible to receive the recommended antivirals despite having met the guideline criteria. It appears even though antiviral scripts can be provided by primary care, there are many road blocks preventing eligible patients from getting "recommended treatment."