Virtual wards held back by lack of public understanding, research suggests

1st August 2023

A lack of understanding of what virtual wards actually are ‘may be holding back’ progress and uptake of the model in the UK, despite evidence of the public being largely supportive of the concept, researchers have suggested.

According to a survey led by The Health Foundation, 45% of the UK public is ‘very‘ or ‘quite‘ supportive of virtual wards, with over a third (36%) saying they were ‘not very‘ or ‘not at all‘ supportive. Some 19% responded that they didn’t know.

However, when asked if they would be happy to monitor their own health at home using technologies, instead of in a hospital – a similar scenario that avoided the term ‘virtual ward’ – support shot up to as many as four in five (78%), compared to just 13% rejecting the idea.

This indicated that a lack of knowledge about virtual wards was ‘stymying support for the policy’, risking slowing the uptake for the model of care, The Health Foundation said.

NHS England is aiming to introduce more than 10,000 virtual ward beds ahead of this winter, including an announcement last month to expand the services to cover children’s care.

Current NHS England guidance is also driving the digitisation of virtual wards, with plans to enhance them through the use of technologies, such as remote monitoring. Similar commitments are also in place in Scotland, Wales and Northern Ireland.

The Health Foundation’s research also found that:

• Support for virtual wards varied on how much one knew about how the NHS uses technology, with those who knew a ‘great deal’ (69%) being more on board that those who didn’t (24%)
• Disabled people (50%), people with a carer (58%) and carers (55%) were more likely to support virtual wards than the population as a whole (45%)
• Older people were more open to using virtual wards under the ‘right conditions’, with only 21% of those over 65 saying they would not want to use one compared to 36% of 16-24 year olds.

The research also included 1,251 NHS staff. Of these, almost two thirds (63%) were either ‘very‘ or ‘quite‘ supportive of virtual wards, while 31% were ‘not very‘ or ‘not at all‘ supportive. When asked what will matter for making sure virtual wards work well, their top two factors were the ability to admit people to hospital quickly if their condition changes, and the ability for people to talk to a health professional if they need help.

Director of innovation and improvement at The Health Foundation, Dr Malte Gerhold, said: ‘It is encouraging to see support for virtual wards is higher among those more likely to require healthcare, such as older people, disabled people and those with a carer. As virtual wards are rolled out, the NHS will need to consider the barriers that households can face and make sure they have the right support available.

‘In the face of unprecedented pressures, the NHS won’t be sustainable in future without greater use of new technologies, so ensuring new ways of delivering care have the backing of patients and the public will be critical if they are to become part of business-as-usual. As well as evaluating virtual wards to ensure they are delivering high-quality care in practice, policymakers need to engage more with the public about how to maximise the potential of better tech-enabled care at home.’

A version of this article was originally published by our sister publication Healthcare Leader.

Nirmatrelvir beneficial against Omicron-related hospitalisations and death in patients over 65

6th September 2022

Nirmatrelvir reduced hospitalisations and death among patients 65 years of age or older during the Omicron surge, but no evidence of benefit was found in younger adults, according the results of an analysis by Israeli researchers.

In December 2021, the US FDA authorised Paxlovid (nirmatrelvir and ritonavir) for the treatment of mild-to-moderate COVID-19 in adults and paediatric patients (12 years of age and older weighing at least 40 kg or about 88 lb.

The combination was also later approved by the EMA in January 2022.

These approvals arose after publication of data from a Phase II-III double-blind, randomised, controlled trial in which symptomatic, unvaccinated, non-hospitalised adults at high risk for progression to severe COVID-19 were randomised 1:1 to receive either 300mg nirmatrelvir plus 100mg ritonavir or placebo every 12 hours for five days.

The results showed that the risk of progression to severe COVID-19 was 89% lower in the treatment group compared with placebo.

However, while seemingly effective, the main circulating COVID-19 variant at the time of the study was Delta and whether the drug maintained efficacy against subsequent variants of concern such as Omicron was uncertain.

In the present study, researchers used a national health database to identify patients 40 years of age and older and who were deemed to be at a high risk of COVID-19 disease progression and therefore eligible to receive nirmatrelvir.

The team set the primary outcome as hospitalisation due to COVID-19 and COVID-19-related death as the secondary outcome. The study started in January 2022 during which time, the Omicron variant was known to be the dominant strain in Israel.

Nirmatrelvir and COVID-19-related outcomes

A total of 109,254 individuals with a mean age of 59.9 years (40% male) were included, of whom 3,902 with a mean age of 67.4 years (40% male) were treated with nirmatrelvir. Overall, 39% of participants were 65 years of age and older and 78% were vaccinated against COVID-19 or had previous immunity due to an infection.

Among those older than 65 given nirmatrelvir, the adjusted hazard ratio (aHR) for hospitalisation was 0.27 (95% CI 0.15 – 0.49) and the risk of a subsequent COVID-19-related death was also significantly lower (aHR = 0.21, 95% 0.05 – 0.82).

But when researchers looked at those aged 40 to 64 years, the adjusted HR for hospitalisation was not significant (aHR = 0.74, 95% CI 0.35 – 1.58) and neither was the risk of COVID-19-related death (aHR = 1.32, 95% CI 0.16 – 10.75).

In subgroup analysis based on previous immunity, the risk for hospitalisation among those aged 40 to 64 years remained non-significant for both without (aHR = 0.23, 95% CI 0.03 – 1.67) and with (aHR = 1.13, 95% CI 0.50 – 2.58) prior immunity.

In contrast, there were significant benefits for patients 65 years and older, irrespective of whether or not they had prior immunity.

The authors concluded that during the Omicron variant surge, there were benefits for older patients administered nirmatrelvir, but it did not provide a benefit for those under 65 years of age in terms of either hospitalisation or death.

Citation
Arbel R et al. Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge. N Engl J Med 2022.