What Does the Public Think About Alternative
Dispensing/Distribution Strategies for
Antivirals?
Summary of IOM Public Engagements
Umair A. Shah, MD, MPH
CDC/ASTHO/NACCHO Nurse Triage Line Stakeholders
Meeting
March 20, 2012
IOM Antivirals Public Engagements:
Purpose
To allow the CDC to receive input from a diverse crosssection of the public on the acceptability of Nurse
Triage Lines and other possible strategies to assist in
the distribution and dispensing of antiviral drugs
during a flu pandemic
2
IOM Antivirals Public Engagements:
The Basics
“Community Conversations” in geographically and demographically
diverse locations with general public participants who reflect the
diversity of their communities
• Series of 4-hour sessions
1.
Frontier Rural: Fort Benton, MT (Feb. 9)
2.
Midsize Urban: Chattanooga, TN (Feb. 16)
3.
Large Metropolitan: Los Angeles, CA (Mar. 2)
• 232 participants total
• Collaboration with local public health and advocacy organizations
on participant recruitment and logistics
• IOM planning committee designed method and tools
3
IOM Planning Committee Membership
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Arthur Kellermann (co-chair), The RAND Corporation
Lisa Koonin (co-chair), Centers for Disease Control and Prevention
Alex Adams, National Association of Chain Drug Stores
Roger Bernier, University of Georgia
James S. Blumenstock, Association of State and Territorial Health Officials
Greg Bogdan, Rocky Mountain Poison Center
Susan Cooper, State of Tennessee
Jack Herrmann, National Association of County and City Health Officials
Ruth Lynfield, Minnesota Department of Health
Suzet McKinney, Tauri Group
Judy Meehan, National Healthy Mothers, Healthy Babies Coalition
Elena Rios, National Hispanic Health Foundation
Carol Rutenberg, Telephone Triage Consulting, Inc.
Umair A. Shah, Harris County Public Health and Environmental Services
4
How We Framed the Issue
“In a Flu Pandemic: Getting Life-Saving Medicines to the Public”
• In a severe pandemic, possible roadblocks
–
–
–
–
–
Many people sick at the same time
Crowded hospitals, doctor’s offices and clinics
Long waits to see a healthcare provider for a prescription
Sick, contagious people in waiting rooms and other public places
People don’t know where to turn for information
• In response, possible new strategies
–
–
To provide quicker access to antiviral drugs
To get medical advice to sick people and the worried well
5
Strategies For Participants’
Consideration
1. Nurse Triage Lines
2. “Collaborative Practice Agreements”
3. Text Message System
4. Friend and Neighbor Pick Up and Delivery
5. Pandemic Flu Website
6
Method and Tools
Surveys and scenarios designed to elicit—
1. Participants’ thoughts about these 5 strategies
– What are their pros and cons?
– Do they seem fair?
– Would they be acceptable if antivirals were in short supply?
2. Participants’ own ideas about how to get antivirals
to the public during a flu pandemic
7
Agenda: Main Features
1. Audience Response System (ARS) pre-survey
2. CDC expert presentation on flu pandemics, antivirals,
and proposed distribution/dispensing strategies
3. Two roundtable scenario discussions
a.
b.
A severe flu pandemic causing long waits to see a healthcare
provider for a prescription
As pandemic continues, antivirals become scarce
4. ARS post-survey
8
Characteristics of Three Sites
Fort Benton, MT
Chattanooga, TN
Los Angeles, CA
75
49
108
Older
Young adult-middle age
Middle age
100% White
(7% Hutterite)
41% African American,
4% Hispanic
> 90% African
American, Hispanic
Educational Level
84% ≥ some college
80% ≥ some college
55% ≥ some college
Health Insurance
Coverage
93%
83%
58%
Nearest Pharmacy
32% > 25 miles
92% < 5 miles
98% < 5 miles
Have called any
medical hotline
62%
64%
42%
Have called a poison
control center
27%
10%
9%
Number of
Participants
Age
Racial/Ethnic
9
High-Level Takeaways
1. Widespread acceptance of concept that there should be
alternative ways for people to access antiviral drugs during a
flu pandemic
2. Broad acceptance of all proposed strategies, including Nurse
Triage Lines and Collaborative Practice Agreements
3. Few significant regional differences across the three sessions
10
The Devil Is In the Details
• Some concerns expressed about-– Capacity of hotlines (need to avoid “cold-lines”)
– Competency (medical, cultural, etc.) of hotline staff
– Streamlining of access
– Locus of control (national vs. local)
– Gaming the system if antivirals are in short supply
• Other comments
– Scarcity scenarios might require different strategies
– Transparency and communication as essential to trust,
acceptance
11
Some Specifics:
Level of Confidence in Normal Systems
1. Split of opinion on whether participants’ normal ways of
getting prescription drugs will work well for them personally
in a pandemic
Disagree
47.2%
Strongly Disagree
32.5%
36.4%
31.3%
31.8%
Agree
Strongly Agree
30.6%
15.3%
6.9%
Fort Benton
18.2%
13.6%
Chattanooga
20.5%
15.7%
Los Angeles
12
Nurse Triage Lines: Trust
2. Vast majority agree that they would trust an NTL nurse to
determine if they needed an antiviral prescription
Disagree
53.5%
56.5%
57.0%
Strongly Disagree
Agree
Strongly Agree
38.0%
30.4%
8.5%
0.0%
Fort Benton
13.0%
0.0%
Chattanooga
26.6%
10.1%
6.3%
Los Angeles
13
NTLs: Safety
3. But, somewhat less agreement about “feeling safe” taking an
NTL-prescribed antiviral without first seeing a healthcare
provider
52.1%
Disagree
Strongly Disagree
48.9%
Agree
39.5%
30.9%
Strongly Agree
21.3%
39.4%
8.5%
0.0%
Fort Benton
25.5%
17.3%
4.3%
Chattanooga
12.4%
Los Angeles
14
NTLs: Children
4. People also are less likely to agree that it would be safe to
use NTLs to prescribe antivirals to children
Note regional variation on this point
Disagree
64.3%
Strongly Disagree
45.9%
46.8%
29.8%
18.6%
15.7%
1.4%
Fort Benton
31.8%
10.6% 12.8%
10.6% 11.8%
Chattanooga
Los Angeles
Agree
Strongly Agree
15
NTLs: Gaming the System
5. General agreement (though not necessarily
concern) that if people can access antivirals through
an NTL, many will lie about their symptoms
40.0%
46.8%
Note regional
variation on
this point
Disagree
Strongly Disagree
Agree
59.2%
Strongly Agree
28.2%
11.3%
48.2%
40.4%
10.6%
1.4%
Fort Benton
2.1%
Chattanooga
4.7%
7.1%
Los Angeles
16
NTLs: Scarcity
6. Split of opinion over whether NTLs could be trusted to get
antivirals to the people who should receive them in times of
scarcity
Disagree
44.7%
50.0% 40.3%
2.8%
6.9%
Fort Benton
36.6%
26.8%
31.9%
12.8% 10.6%
Chattanooga
Strongly Disagree
Agree
Strongly Agree
19.5% 17.1%
Los Angeles
17
Collaborative Practice Agreements
7. Vast majority would trust pharmacists working under a CPA to
prescribe an antiviral drug
Disagree
41.7%
53.3%
Strongly Disagree
55.6%
Agree
Strongly Agree
55.6%
42.2%
30.9%
2.8%
0.0%
Fort Benton
4.4%
0.0%
Chattanooga
9.9%
3.7%
Los Angeles
18
Information via Text Message
8. Most would like to be able to sign up to receive text messages
about the antiviral drugs that they had been prescribed (e.g.,
side effects, reminders to take medicine)
41%
59%
Disagree
52%
Strongly Disagree
Agree
Strongly Agree
44%
31%
16%
11%
2%
4%
Chattanooga
Los Angeles
30%
10%
0%
Fort Benton
19
Generally speaking…
9. Strong agreement that even if there are small risks to
changing the ways people get antivirals, it is better for more
people to get them in time
34.7%
41.3%
Disagree
38.6%
Strongly Disagree
Agree
Strongly Agree
63.9%
52.2%
1.4%
0.0%
Fort Benton
51.8%
6.5%
0.0%
Chattanooga
6.0%
3.6%
Los Angeles
20
Final Takeaways
1. Widespread acceptance of NTLs and CPAs
– Concerns increase when children, scarcity at issue
2. Conversations mainly increased acceptance of proposed strategies
3. Participant evaluation reflected consistent, broad agreement that-– The information presented was trustworthy and helped them
understand the challenges of getting antivirals to the public in a
pandemic
– The scenario discussions were productive and allowed them to
express their views
– It was useful to hear other participants’ opinions
– By the post-survey, they had a better understanding of the issues
– They would recommend that family and friends participate in a
similar session if offered the chance
21
DISCUSSION
22