RESUMEN
Clinical pharmacists are an untapped resource in the fight against health disparities. As frontline workers, they are embedded in communities and interact on a regular basis with patients managing chronic conditions. In particular, managed care clinical pharmacists have access to population-wide data to identify gaps and mobilize resources to proactively address disparities across their community. Amid the current pandemic, there have been vast inequities regarding access to the coronavirus disease 2019 (COVID-19) vaccine, particularly for low income and underserved culturally specific populations. The pandemic has provided a case study for how clinical pharmacists can collaborate across managed care and community-based settings to work toward achieving health equity. Recent data indicates that culturally specific populations have received less COVID-19 vaccines than the White population. To address this inequity, a team of clinical pharmacists at CareOregon, a health plan in Oregon that serves Medicaid, collaborated with retail pharmacists from both chain and independent pharmacies to improve COVID-19 vaccination rates for this unique population. This paper describes the process and strategies implemented to ensure vaccine access for culturally specific populations enrolled with CareOregon. Strategies to expand vaccine access to this population involved data sharing with community pharmacists, direct scheduling of culturally specific members for vaccine appointments and partnering with other stakeholders such as community-based organizations (CBOs) to provide COVID-19 vaccine confidence training. This paper also highlights the impact of the strategies to improve COVID-19 vaccination rates for this population. Lastly, challenges and barriers are addressed, as well as lessons learned from this process.
RESUMEN
OBJECTIVE: To determine the prevalence of D-dimer elevation in coronavirus disease 2019 (COVID-19) hospitalization, trajectory of D-dimer levels during hospitalization, and its association with clinical outcomes. Approach and Results: Consecutive adults admitted to a large New York City hospital system with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 1, 2020 and April 8, 2020 were identified. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>230 ng/mL). Outcomes included critical illness (intensive care, mechanical ventilation, discharge to hospice, or death), thrombotic events, acute kidney injury, and death during admission. Among 2377 adults hospitalized with COVID-19 and ≥1 D-dimer measurement, 1823 (76%) had elevated D-dimer at presentation. Patients with elevated presenting baseline D-dimer were more likely than those with normal D-dimer to have critical illness (43.9% versus 18.5%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), any thrombotic event (19.4% versus 10.2%; adjusted odds ratio, 1.9 [95% CI, 1.4-2.6]; P<0.001), acute kidney injury (42.4% versus 19.0%; adjusted odds ratio, 2.4 [95% CI, 1.9-3.1]; P<0.001), and death (29.9% versus 10.8%; adjusted odds ratio, 2.1 [95% CI, 1.6-2.9]; P<0.001). Rates of adverse events increased with the magnitude of D-dimer elevation; individuals with presenting D-dimer >2000 ng/mL had the highest risk of critical illness (66%), thrombotic event (37.8%), acute kidney injury (58.3%), and death (47%). CONCLUSIONS: Abnormal D-dimer was frequently observed at admission with COVID-19 and was associated with higher incidence of critical illness, thrombotic events, acute kidney injury, and death. The optimal management of patients with elevated D-dimer in COVID-19 requires further study.