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image  Promote infection control and social distancing (including school and house of worship closings) to minimize spread of disease and ultimately conserve limited resources

Reported goals and values varied somewhat between the two scenarios. When adequacy of the supply of antiviral medications was not at issue, individual participants spent more time considering safety concerns. When scarcity was introduced as a condition, discussions tended to include issues of the equitable or utilitarian prioritization strategies for allocating the limited supply of antivirals. Although transparency was often voiced as an important value in both scenarios, it received even more attention in the context of scarcity across all three sites. However, no matter the scenario, trust was a common theme expressed by several participants in Fort Benton and Chattanooga. These participants described their general trust in the intentions of and the capability of nurses, pharmacists, and physicians to perform their jobs. Some participants in Los Angeles, alternatively, were more skeptical of the health care system to provide care equitably and efficiently during routine operations, and expressed heightened feelings of mistrust in their institutions during emergencies.

Nurse Triage Lines

Using NTLs as an alternative strategy for increasing access to prescriptions for antivirals during a pandemic received the most extensive focus at the community conversations. Participants were introduced to the concept of NTLs through several statements in the ARS presurvey, and again in the expert slide presentation. The presentation offered a high-level description of NTLs that included the following information:

•  NTLs are hotlines that people who are sick with flu-like symptoms could call for advice, to discuss whether an antiviral medication is indicated, and, if so, to receive a prescription that the NTL would transmit to callers’ local pharmacies for dispensing.

•  NTLs would be staffed by nurses who would be trained to follow a specific protocol and work under the direction of a physician.

•  NTLs would be built on existing regional hotline infrastructure (e.g., poison control centers, 2-1-1) and might leverage other hotlines currently operated by health plans, hospitals, and health agencies.

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