ACT Teams + Athelas: Ensuring People with Schizophrenia Have Access to Care during a Pandemic

Introduction

Assertive Community Treatment (or ACT) teams often provide care to people taking the antipsychotic clozapine. To help their patients get the required venous draws to test for white blood cells (WBC) and absolute neutrophil count (ANC), they currently have to arrange transportation to an off-site lab.

With the Athelas One device, an FDA-cleared fingerstick hematology analyzer that reports WBC and ANC, they can take the test directly into patients’ homes.

The Athelas One, an FDA-cleared hematology analyzer. We use machine learning and computer vision to calculate WBC and ANC. The machine is small and portable — perfectly suited to bring into the field.

It has been a more convenient and efficient solution for the >25 ACT teams currently using the Athelas device, and during COVID-19 has become the only safe way for patients on clozapine to get their tests.

What’s Clozapine?

Clozapine is a drug taken by people with schizophrenia, particularly when they have not responded to other medications and are diagnosed with “treatment resistant” schizophrenia (TRS). Clozapine has been shown to:

• Improve both negative symptoms like social avoidance and positive symptoms like hallucinations
• Reduce ER visits, hospitalizations, and deaths associated with schizophrenia

However, clozapine can reduce the production of white blood cells (WBCs), especially a type of white blood cell called neutrophils, rendering people taking the drug defenseless against severe infections. As a result, people on clozapine have to have their WBCs and absolute neutrophil count (ANC) monitored via frequent blood draws. The process can be painful and inconvenient enough that people stop taking the drug, even though it’s effective.

What does Athelas do?

The Athelas One device measures WBC + ANC using one drop of blood from a fingerstick sample. It’s similar to how you test your blood sugar: use a small lancet to get a drop of blood from your finger, put it on a test strip, and put it in the machine. It’s less painful than venous draws, and can be done at the pharmacy, psychiatrist’s office, or even patients’ homes.

Our goal is to increase access to clozapine by making the experience better for patients and consolidating services in fewer places.

The Athelas One needs only < 3uL of blood. We use machine learning and computer vision to calculate White Blood Cell (WBC) counts and Absolute Neutrophil Counts (ANC).

The Athelas + ACT partnership

What are ACT teams?

ACT teams serve people with serious mental illness in a holistic way, in a community setting. (See this post by Verywell Mind.) Because people on clozapine have schizophrenia, and schizophrenia is classified as a serious mental illness, their care is often coordinated through ACT teams. These teams typically help people on clozapine meet their testing requirements by arranging transportation to lab facilities, e.g. calling a cab or driving the patient themselves. ACT nurses also might draw the patient’s blood and send it out to a separate lab.

The current ACT workflow is costly and more painful for patients because it requires transportation to and from a lab for venous blood draws

How does Athelas improve the workflow?

The goal of ACT teams is to provide care in the most convenient way for the people they serve. Insurance companies not only cover ACT but encourage the creation of more ACT teams. ACT has been shown to increase medication adherence for clozapine, and clozapine adherence benefits the end payor by keeping costs low (reducing ER visits and inpatient hospitalizations).

Because Athelas makes WBC + ANC testing less painful and more convenient, it’s a natural partnership.

Instead of arranging transportation to the lab, the ACT team can bring the test directly to the patient’s home and get results within minutes. The experience is less time-consuming, less expensive, less painful, and more personal. We currently work with >25 ACT teams to help people on clozapine meet their testing requirements.

The ACT workflow with Athelas is less expensive and less painful, because an ACT team member can drive directly to the patient’s house and collect the sample via fingerstick (like you would for blood glucose monitoring) instead of venous draw

ACT teams and the pandemic

COVID-19 has introduced many challenges that ACT teams now need to overcome to monitor patients effectively

Centralized labs increase risk of contraction

First, patients might not want to go to lab facilities at all, as lab visits may increase their risk of exposure to the coronavirus. People on clozapine are already at higher risk of infection, particularly pneumonia, especially if their WBCs are too low. Additionally, there is evidence that COVID-19 may cause clozapine toxicity, where the levels of the drug circulating in a person’s blood become too high and they have physical side effects.

Between the risk of infection and the risk of clozapine toxicity, patients clearly benefit by avoiding centralized labs.

Transportation to labs is costly and potentially unsafe

ACT workflow without the Athelas One, during COVID-19. Two people must be transported to and from the lab separately, which still generates risk.

Secondly, even if people on clozapine are willing and able to go to a lab, how they get there can be dangerous. Public transportation, or an ACT team member driving the patient, increase risk of exposure. ACT teams who don’t have the Athelas device have been adapting by ordering ride shares like Uber for patients, which increases transportation cost. A team member will drive separately and meet the patient at the lab to provide support. Then they call another Uber for the patient and drive home. Notably, this set-up still requires a patient to be in a confined space with another person.

How Athelas helps

For ACT teams who do have the Athelas One device, though, there are more options. The Athelas One is small and hardy, so can be easily transported. It can be operated by anyone who has been trained by Athelas staff, so you don’t need a certified phlebotomist. A trained ACT nurse can bring the machine to a patient’s home, and run a test in about five minutes.

That reduces risk by…

1. Reducing the number of people in the room. A private setting like an individual house or a group home will have fewer people than a public place like a lab facility, and the people living there have more control over how/how often it is cleaned.
2. Reducing the amount of time the person on clozapine and the nurse are close to each other. Getting one drop of blood from your finger is quicker than a full blood draw from a vein, and less contact time means less risk of exposing each other to the coronavirus.

Using the Athelas One reduces both the number of people in the room during the test and the amount of time they have to spend together.

We’re also working with our >25 ACT partners to make using the device on-the-go easier. For instance, the Athelas One can be operated entirely using a mobile phone making it easier than ever for ACT teams on the go.

We also partner with Golden Gate Pharmacy to deliver clozapine directly to people’s homes. Preventing a pharmacy visit reduces risk the same way preventing a lab visit does.

Conclusion

For people who have been taking clozapine for less than a year, and people whose ANC has been too low before, testing is still the safest option despite COVID-19 risk. Otherwise, their ANC could plummet, and they could develop a deadly infection; but testing needs to happen in a way that reduces risk of coronavirus transmission. The number of people in a group and the amount of time those people spend in close contact with each other are two of the biggest risk factors.

The Athelas One has always provided flexibility, mobility, and a faster test, making it a fantastic resource for ACT teams. Now, the fringe benefits of those features — fewer people in the room, minimal contact time — are emerging as its most important aspects.

If you’re interested in learning more, please email us at clinic@athelas.com, or email Kat directly at kat@getathelas.com. We’d love to hear from you!