Factors Associated with The Speed and Scope of Diffusion of COVID-19 Therapeutics in a Nationwide Healthcare Setting: A Mixed Methods Investigation

Abstract Background: The global COVID-19 pandemic is an opportunity to evaluate factors associated with high levels of adoption of different therapeutics in a real-world setting. The aim of this nationwide, retrospective cohort study was to evaluate the diffusion and adoption of novel therapeutics with an emerging evidence basis and to identify factors that influenced physicians’ treatment decisions. Methods: Cohort Creation: A cohort of Veteran patients with a microbiologically-confirmed diagnosis of SARS-CoV2 was identified and cases were classified by disease severity (outpatient, inpatient with mild and severe disease, ICU). After classification of disease severity, proportion of cases (outpatients) and admissions (inpatients) in each category receiving each type of medication were plotted as a function of time. Identification of Milestones and Guidance Changes: Key medications used for the management of COVID-19 milestones in the release of primary research results in various forms (e.g., via press release, pre-print, or publication in a traditional medical journal), policy events, and dates of key guidelines, were identified plotted as a timeline. After a timeline was created, timepoints were compared to changes in medication use, and factors potentially impacting the magnitude (i.e., proportion of patients who received the treatment) and the speed (i.e., the slope of the change in use) of practice changes were evaluated. Results: Dexamethasone and remdesivir, the first two medications with clinical trials data to support their use underwent the most rapid, complete, and sustained diffusion and adoption; the majority of practice changes occurred after press releases and pre-prints were available and prior to guideline changes, although some additional uptake occurred following guideline updates. Medications that were not “first in class,” were identified later in the pandemic, and that had higher perceived risk had slower and less complete uptake regardless of the strength and quality of the evidence supporting the intervention. Conclusions: Our findings suggest that traditional and social media platforms and pre-print releases were major catalysts of practice change, particularly prior to the identification of effective treatments. The “first available treatment in class” impact appeared to be the single most important factor determining the speed and spread of diffusion. Clinical Trial Registration: Not applicable.

Medienart:	Preprint

Erscheinungsjahr:	2022
Erschienen:	2022

Enthalten in:	ResearchSquare.com - (2022) vom: 27. Sept. Zur Gesamtaufnahme - year:2022

Sprache:	Englisch

Beteiligte Personen:	La, Jennifer [VerfasserIn] Fillmore, Nathanael R [VerfasserIn] Do, Nhan V [VerfasserIn] Brophy, Mary [VerfasserIn] Monach, Paul A [VerfasserIn] Branch-Elliman, Westyn [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	570 Biology

doi:	10.21203/rs.3.rs-1899144/v2

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	XRA037317059