HCV Screening, Care Model Intervention Improve Patient Outcomes

Vincent Lam, PharmD

Credit: LinkedIn

Routine screening, telehealth services, and an interdisciplinary team approach may have a positive impact on hepatitis C virus (HCV) diagnosis and management, according to findings from a retrospective cohort study.

Among a cohort of nearly 100 patients screened for and diagnosed with HCV, a greater proportion of patients exposed to an intervention with automated routine HCV screening and the addition of a clinical pharmacist to the interdisciplinary patient care model completed treatment and achieved sustained virological response (SVR) compared to patients who were not exposed to the intervention.¹

“Testing for hepatitis C in hospital emergency departments and linkage to care to clinics have been reported to provide the most opportunity for screening patients and facilitating continuum of care. Treatment model initiatives have expanded to include telehealth services and open treatment capacity to non-physician providers, such as pharmacists,” wrote investigators.¹

Globally, the World Health Organization (WHO) estimates 58 million people have chronic HCV infection, with about 1.5 million new infections occurring per year. The WHO’s global hepatitis strategy aims to reduce new hepatitis infections by 90% and deaths by 65% by 2030. Although direct-acting antivirals (DAAs) ​​can cure more than 95% of HCV infections, screening opportunities and access to treatment remain limited for many patients, a shortcoming that must be addressed if the WHO’s goal is to be achieved.²

To assess the implementation of automated routine screening as well as an interdisciplinary patient care model on diagnosis and treatment outcomes, Vincent Lam, PharmD, PGY2 ambulatory care pharmacy resident at the University of Maryland School of Pharmacy, and colleagues retrospectively examined the electronic health records, self-tracking database from the FOCUS team, and medical charts of patients screened and diagnosed with HCV at Jersey City Medical Center and linked to care at the Center for Comprehensive Care. Patients were excluded if they were diagnosed with HCV outside of the study’s pre- and post-intervention periods, declined referral to linkage to care established by the FOCUS team, or were diagnosed with HCV with hepatocellular carcinoma.¹

In total, 83 eligible patients were identified and retrospectively enrolled in the study. Ages ranged from 27 to 83 years across the total study population. Participants were divided into 2 groups based on exposure to the study interventions: the implementation of automated routine HCV screening in the emergency department and the addition of a clinical pharmacist to the interdisciplinary patient care model.¹

The pre-intervention group included 46 patients who were seen prior to the implementation of routine screening and the interdisciplinary patient care model from June 2018 to June 2019, while the post-intervention group included 37 patients who were seen after both implementations from June 2020 to June 2021.¹

The study’s primary endpoints were the number of patients who achieved sustained virologic response after 12 weeks of treatment (SVR12) and patients who completed treatment with no reported record of SVR12. Secondary endpoints were the number of patients lost to follow-up, appointment type, time spent in appointments, and clinical pharmacist specialist interventions.¹

Treatment was completed by 18 (39.1%) patients in the pre-intervention group and 21 (56.8%) in the post-intervention group. SVR12 was achieved by 11 (23.9%) patients in the pre-intervention group and 12 (32.4%) patients in the post-intervention group.¹

Further analysis with chi-square tests revealed no statistically significant results in patients who completed treatment (P = .11) and patients who achieved SVR12 (P = .39). However, investigators noted statistically significant results (all P < .05) between the pre- and post-intervention groups for patients lost to follow-up (80.4% vs 35.1%), documented appointments for initiation of HCV treatment (32.6% vs 78.4%), patients who answered follow-up calls (6.5% vs 73%), and medication reconciliation being completed and documented (6.5% vs 75.7%), respectively.¹

“Results of this study showed the positive impact on the implementation of routine screening, telehealth services, and an interdisciplinary team approach to HCV diagnosis and management. Given the timeframe, it also showed the potential positive impact on these interventions, even during a global pandemic,” investigators concluded.¹ “These interventions were implemented out of best practice measures and hepatitis C programs and initiatives should continue to be prioritized to promote HCV elimination efforts.”

References:

1. Lam V, Dimaculangan C. Impact of an interdisciplinary patient care model and routine screening on clinical outcomes in patients with hepatitis C. Innov Pharm. 2023;14(2):10.24926/iip.v14i2.5114. Published 2023 Oct 10. doi:10.24926/iip.v14i2.5114
2. World Health Organization. Elimination of hepatitis by 2030. Hepatitis. Accessed December 15, 2023. https://www.who.int/health-topics/hepatitis/elimination-of-hepatitis-by-2030