Hepatitis C Treatment Impacted by Pharmacist Integration in Care Team

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Researchers found that an innovative hepatitis C care program had positive outcomes after the integration of pharmacists onto the care team.
Researchers found that an innovative hepatitis C care program had positive outcomes after the integration of pharmacists onto the care team.

Structured integration of pharmacists with limited prescriptive authority into hepatitis C virus (HCV) care teams may allow ambulatory clinics to increase their capacity and enhance patient care, according to research published in the Journal of the American Pharmacists Association.1

In 2014, pharmacists were incorporated into the HCV care team across the Miami Veterans Affairs (VA) Healthcare System, with the intention to provide “expert pharmacotherapy resources” to patients while assisting providers and maximizing treatment adherence and safety.

Treatment methods were modeled by observing current pharmacist functions within other VA outpatient areas. The clinic—previously staffed by 1 pharmacist who provided twice a week face-to-face services—increased the number of pharmacy staff members to include an HCV pharmacist, an HIV/AIDS pharmacist, and an antimicrobial pharmacist. Additional members of the HCV care team included 2 hepatologist physicians and a hepatology advance registered nurse practitioner (ARNP). The timeline for weeks 0-8 of a 12-week HCV treatment regimen (adapted from Drs Gauthier et al) is below: 

Table. Timeline and tasks for weeks 0-8 of a 12-week HCV treatment regimen.

Week Clinic Visit or Task
0 –Physician or ARNP encounter followed by pharmacist encounter.
–Pharmacist dispenses 2 weeks of HCV medication.
2 –Pharmacist encounter.
–Pharmacist dispenses 2 weeks of HCV medication.
4 –Pharmacist encounter.
–Pharmacist dispenses 4 weeks of HCV medication.
8 –Physician or ARNP encounter.
–Pharmacist dispenses 4 weeks of HCV medication.

At 12 weeks, patients conducted a pharmacist encounter via telephone, and at 24 weeks, a medical hepatology encounter to determine the patient's sustained virologic response at 12 weeks (SVR-12) and answer any final patient inquires.

To determine the HCV care team's success, a de-identified data set of all enrolled patients was acquired from the hepatology pharmacy quality assurance database. Data were presented regarding drug utilization and successful treatment.

Between January 2014 and September 2015, 1619 pharmacists encountered 532 unique patients (median age, 62 years; 96% male) and performed 597 screenings, with initiation of 565 total HCV treatment courses. The most common HCV genotypes were 1a (62%) and 1b (30%). Pharmacists most commonly prescribed sofosbuvir (47%), ledipasvir/sofosbuvir (38%), and simeprevir (34%); 260 of the HCV treatment courses were completed. Treatments were most commonly stopped due to poor medication adherence (4%), adverse drug reaction (28%), partial virologic response to therapy (14%), death (14%), and no response to therapy (7%).

“Inter-professional collaboration between pharmacists with limited prescriptive authority and medical HCV providers has contributed to a robust practice model and enabled more than 500 patients to begin treatment,” wrote Timothy P. Gauthier, PharmD, BCPS-AQ ID, the antimicrobial stewardship and infectious disease pharmacist at the Miami VA, and colleagues.

Dr Gauthier and colleagues note that one important contribution made by pharmacists was the total number of patients undergoing HCV therapy was increased without overburdening the VA's HCV physicians.

“Data exist supporting pharmacists as nonphysician providers, but an integrative approach of combining pharmacy and medicine providers was appealing because it allowed for patients to be assessed and monitored by both diagnostic and pharmacotherapy experts,” the researchers wrote.

Study Limitations

  • Data for many patients' sustained virologic response at 12 weeks (SVR-12) was not available at the time the analysis was performed, due to the ongoing nature of the treatment program.
  • Workload data is provided but is not extensive.
  • The researchers lacked historical data and a control group of patients who had no pharmacist involvement in their treatment.
  • Patient satisfaction was not objectively assessed.

Disclosures: The authors declare no conflicts of interest.

Reference

  1. Gauthier TP, Moreira E, Chan C, et al. Pharmacist engagement within a hepatitis C ambulatory care clinic in the era of a treatment revolution. J Am Pharm Assoc. 2016. doi: 10.1016/j.japh.2016.06.013
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