Category: Professional Posters
Purpose: Palivizumab is a monoclonal antibody used to prevent serious lower respiratory tract infections caused by respiratory syncytial virus (RSV) in high-risk infants and children. Per American Academy of Pediatrics (AAP) recommendations, at our institution palivizumab is provided at discharge for high-risk patients to prevent community-associated RSV transmission. Monthly follow-up doses are to be provided by primary care providers for the duration of RSV season. As low compliance increase morbidity and mortality, this project was designed to assess outpatient compliance rates and to determine if a reminder call by a pharmacist increased compliance for the first dose after discharge.
Methods: All patients that received a dose of palivizumab at discharge between November 2017 and March 2018 were included in this analysis. Pharmacists called the primary care provider for each patient one week prior to the first required dose after discharge. If the patient was not scheduled to receive palivizumab at their PCP's office, the office was asked to schedule an appointment with the patient. For those patients where this reminder was necessary, another follow-up call one week after the required dose was made to determine if the reminder call was successful in eliciting a dose. If the dose was still not provided in spite of the reminder, the PCP office was asked to identify barriers to access, including insurance coverage. Patients were excluded from the analysis if the follow-up dose fell outside the RSV season; if the patient was discharged to a step-down facility; if the dose was provided before discharge; if the PCP was unknown; if the patient was readmitted with RSV; or if the patient received multiple inpatient doses.
Results: A total of 86 palivizumab doses were provided for 76 unique patients in the 2017-2018 RSV season, of which 46 patients were ultimately included in the analysis. There were 29 females (63%) and 17 males (37%) with an average age of 4.67 months at the time of the first dose. After discharge, 33 (71.7%) patients had an appropriate follow-up scheduled with their PCP for a follow-up palivizumab dose. After the reminder call, an additional 5 patients received a dose and increased compliance to 82.6%. Of the 8 patients that did not receive a dose, 7 had commercial insurance. Insurance coverage, including the time needed to complete prior authorizations, was reported as the biggest hurdle in the timely administration of follow-up doses. Of the 13 patients that were initially non-compliant, discharge summaries were also found to lack appropriate guidance on the need for follow-up doses, including lack of a specific date for the administration of the initial inpatient dose and/or specific date for the follow-up dose.
Conclusion: This analysis of compliance rates of palivizumab showed room for improvement in ensuring outpatient compliance. We found that a significant amount of complex information is transmitted to a PCP office upon discharge, and discrete fields that provide specific instructions on follow-up needs is a necessary component of discharge summaries. Additionally, in contradiction to published data, our study found that patients with commercial insurance had more barriers to access than those with Medicaid. Follow-up reminder calls improved compliance, and calls made soon after discharge may improve compliance further. This data supports the need for dedicated personnel to coordinate outpatient palivizumab.