P-2027. Care at Home for Remdesivir Treatment of COVID-19: A Mixed Methods Study of Patient and Physician Experiences

Abstract Background Hospital in the home and virtual models of care were rapidly implemented during the COVID-19 pandemic. We sought to assess patient and provider perspectives of care at home integrating a three or five-day remdesivir (RDV) treatment regimen in a large integrated health care system in California.Figure 1.Patient Survey Recruitment Consort Flow Diagrama. Identified as unreachable prior to and during recruitment (deceased, no longer health system members, cognitive impairment, invalid contact information)b. Lost to follow- no response after exhausting all contacts Methods A mixed methods study was conducted to assess patient and physician experiences using an online/telephone survey questionnaire developed based on components of the Health Belief Model and Hospital Consumer Assessment of Healthcare Providers. Patients > 18 years of age who received RDV in the outpatient setting (N=1544) and prescribing physicians (N=406) from December 15, 2020-August 31, 2022 were eligible. Descriptive statistics were used to describe categorical responses. A cross-sectional analysis was performed to identify factors associated with patient adherence defined as taking > 80% of prescribed doses and physician adoption of treatment guidelines. Qualitative data were triangulated to determine whether patient/prescriber perceptions about value were validated by health outcomes measured as reduction of COVID-19 related readmission within 30 days of entry into treatment program.Figure 2.Provider Survey Recruitment Consort Flow Diagrama. No longer health system providersb. Lost to follow-up- no response after exhausting all contacts Results Of 540 patient respondents (response rate: 38%, mean age: 58.4 years (SD 16.2), 55.2% male), the majority was of Hispanic ethnicity (48.4.2%), followed by White (32.3%), and Black (12.6%). Of 140 physician respondents (response rate: 34%, mean age: 46.9 years (SD 8.4), 58% male), the majority was of Asian ethnicity (65.8%), followed by White (23%), and Hispanic (7.1%). Adherence was found in 99% of patients having completed > 80% of RDV doses. Adherent patients reported returning to their own home (95.2%), nurses always listened to them (87%), and high health literacy (65%). Feeling knowledgeable was significantly associated with physician prescribing of new unfamiliar medications while under emergency use authorization. (p=0.0007). Patients (80.3%) reporting “Very Satisfied” with medical follow-up were less frequently readmitted within 30 days. (p=0.045) Conclusion Patients and physicians responded favorably to value-based care at home integrating RDV for treatment of COVID-19. This finding is key to informing future design of alternative modes of health care delivery. Disclosures Julia K. Nguyen, PharmD, Gilead Sciences: Grant/Research Support Rulin C. Hechter, MD, PhD, MS, Gilead Sciences: Grant/Research Support William Towner, MD, GSK: Grant/Research Support|Janssen: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support