555 - Effectiveness of a Treatment Team on Adherence to Health System Guidelines for Hydroxychloroquine Use During Two Phases of the COVID-19 Epidemic

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Presenting Author(s)

Alex Viehman

Clinical Assistant Professor
University of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

MN

M. Hong T. Nguyen

Professorof Medicine
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
WG

Will Garner

Infectious Diseases Fellow
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Anna Apostolopoulou

Resident
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GH

Gavin H. Harris

Infectious Diseases/Critical Care Medicine Fellow
University of Pittsburgh School of Medicine
Pittsburgh, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AL

Aaron Lucas

Fellow
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VJ

Vidya Jagadeesan

Fellow
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SB

Sharlay Butler

Fellow
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GR

Glen J. Rapinski

Fellow
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Erin K. McCreary

Director of Infectious Diseases Improvement and Clinical Research Innovation
University of Pittsburgh Medical Center
Pittsburgh, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ricardo Arbulu

Clinical Assistant Professor Division of Infectious Diseases
University of Pittsburgh Medical Center
PITTSBURGH, PA, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SG

Steven Ganchuk

Clinical Pharmacy Specialist
UPMC Mercy
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AY

Anne Yang

Resident
UPMC Mercy
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AA

Amitha Avasarala

Resident
UPMC Mercy
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RT

Rosalie Trificante

Resident
UPMC Mercy
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RB

Rahul Bollam

Resident
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RZ

Richard H. Zou

Fellow
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KM

Kaveh Moghbeli

Fellow
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MD

Malik Darwish

Resident
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AH

Amit Hemadri

Physician
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Erin Weslander

Clinical Pharmacist
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BC

Brian T. Campfield

Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA; Richard K. Mellon Institute for Pediatric Research
Pittsburgh, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Marian G. Michaels

Professor
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ghady Haidar

Assistant Professor of Medicine
University of Pittsburgh School of Medicine
Pittsburgh, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JD

Jesssica Daley

VP
UPMC
Pittsburgh, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Elise M. Martin

Medical Director
VA Pittsburgh Healthcare System
Pittsburgh, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JB

J. Ryan Bariola

Clinical Associate Professor of Medicine
University of Pittsburgh Medical Center, Infectious Disease Connect
Pittsburgh, Pennsylvania
Disclosure: Infectious Disease Connect (Employee)Mayne Pharma (Advisor or Review Panel member)Merck (Research Grant or Support)

Background: Our hospital system created system guidelines to standardize care across 24 hospitals for COVID-19 treatment during the pandemic. Guidelines changed over time. Hydroxychloroquine (HCQ) was unrestricted during phase 1, then restricted by pharmacy outside of a randomized clinical trial (RCT) during phase 2 (excepting those ineligible for RCTs).

Methods: This was a prospective study to assess system-wide adherence to COVID-19 treatment guidelines, and to evaluate patient outcomes.

Results: Of 261 patients, median age was 67 years (IQR 56-76); 49% (129/261) were male, and 45% (118/261) required ICU care.
Overall, 47% (122/261) were in phase 1; HCQ was offered to 57% (69/122) during this phase. The rate of HCQ prescription in phase 2 decreased significantly to 10% (14/136), (p < 0.001). Adherence to COVID-19 treatment protocol was 97% (135/139) during phase 2. Mortality was similar in both phases (22% vs 28%, p=0.32), as was median length of stay (8 vs 7 days, p=0.3). Overall 66 patients (25%) died in the hospital; neither non-adherence (p=1) to system guidelines nor receipt of HCQ (p=0.17) were risk factors for death.
Independent predictors of mortality included: new renal replacement therapy (OR 61, 95%CI 6.7-560, p < 0.001), mechanical ventilation (OR 4.9, 95%CI 2.0-11, p < 0.001), abnormal chest X-ray (OR 4.3, 95%CI 1.4-12.6, p =0.009), history of heart failure (OR 3.9, 95%CI 1.5-11, p=0.006), lack of fever on admission (OR 3.5, 95%CI 1.7 -7.6, p =0.001), receipt of corticosteroids (OR 2.7 95%CI 1.1-6.6, p=0.026) and increased age (OR 1.07 per year, 95%CI 1.04-1.1, p < 0.001). Bacterial pneumonia occurred in 8% (21/261), more commonly in those who died (p=0.02). Black patients had a higher race-specific death rate (308 vs 197) per 1000 than white patients (p< 0.001).

Conclusion: During the COVID-19 pandemic, our health system guidelines and pharmacy restrictions were successful in delivering consistent care across hospitals. Restriction of HCQ for COVID-19 treatment to RCTs reduced its use in phase two. Non-adherence to systemic guidelines was infrequent, and not associated with adverse outcomes. A COVID-19 treatment team of physicians and pharmacists can effectively coordinate therapy across hospitals in the setting of rapidly changing guidelines.