Local specialty pharmacy and specialty clinic collaboration assists access to hepatitis C direct-acting antivirals

Zhu, Julia; Hazen, Ron; Joyce, Cara; Delpino, Ambrose; Kirkham, Heather; Strickland, Carson D.; Markes-Wilson, Shauna; Kim, Tomeka; Kang, Meen; Rubin, Raymond A.; Stein, Lance L.

doi:10.1016/j.japh.2017.10.011

Cited by 11 publications

(5 citation statements)

References 24 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Measures to improve treatment initiation, the focus of this analysis, have included patient education and outreach, colocalization of services, nonspecialist hepatitis C treatment education and care delivery, use of telemedicine, patient navigation programs, and cost management approaches to help defray out-of-pocket expenses. (33)(34)(35)(36) In recent years, government-affiliated health care systems, such as in the U.S. Department of Veterans Affairs, Cherokee Nation, and Alaskan Native Tribal Health Consortium, have demonstrated remarkable improvements in DAA access and uptake, illustrating the potential advantages of unified health delivery systems with relatively homogeneous patient populations. (37)(38)(39)(40) In the private sector, specialty clinics embedded within large health care organizations also have demonstrated the capacity to improve DAA access.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

et al. 2020

View full text Add to dashboard Cite

for the Chronic Hepatitis Cohort Study (CHeCS) Investigators There are limited data examining the relationship between psychosocial factors and receipt of direct-acting antiviral (DAA) treatment among patients with hepatitis C in large health care organizations in the United States. We therefore sought to determine whether such factors were associated with DAA initiation. We analyzed data from an extensive psychological, behavioral, and social survey (that incorporated several health-related quality of life assessments) coupled with clinical data from electronic health records of patients with hepatitis C enrolled at four health care organizations during 2017-2018. Of 2,681 patients invited, 1,051 (39.2%) responded to the survey; of 894 respondents eligible for analysis, 690 (77.2%) initiated DAAs. Mean follow-up among respondents was 9.2 years. Compared with DAA recipients, nonrecipients had significantly poorer standardized scores for depression, anxiety, and life-related stressors as well as poorer scores related to physical and mental function. Lower odds of DAA initiation in multivariable analysis (adjusted by age, race, sex, study site, payment provider, cirrhosis status, comorbidity status, and duration of follow-up) included Black race (adjusted odds ratio [aOR], 0.59 vs. White race), perceived difficulty getting medical care in the preceding year (aOR, 0.48 vs. no difficulty), recent injection drug use (aOR, 0.11 vs. none), alcohol use disorder (aOR, 0.58 vs. no alcohol use disorder), severe depression (aOR, 0.42 vs. no depression), recent homelessness (aOR, 0.36 vs. no homelessness), and recent incarceration (aOR, 0.34 vs. no incarceration). Conclusion: In addition to racial differences, compared with respondents who initiated DAAs, those who did not were more likely to have several psychological, behavioral, and social impairments. Psychosocial barriers to DAA initiation among patients in care should also be addressed to reduce hepatitis C-related morbidity and mortality. (Hepatology Communications 2020;0:1-12). P ublic health prevention and control of hepatitis C entails identification of infected persons through universal testing, followed by linkage to clinical services and ensuring that persons linked to care receive and complete effective treatment. (1-5) On an individual level, eradication of hepatitis C virus (HCV) infection eliminates the possibility of HCV transmission to others and reduces morbidity and mortality from HCVattributable hepatic and extrahepatic disease among persons who no longer engage in transmission-associated behaviors. (4) Despite radical improvement in the treatment of HCV infection since the release of secondgeneration direct-acting antiviral (DAA) medications, uptake of these drugs in many U.S. general health care

show abstract

Section: Discussionmentioning

confidence: 99%

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Through coordinated care between the clinic and the specialty pharmacy, 98.1% of patients being treated for HCV had an out-of-pocket cost of $20 or less per month. 12 Bagwell et al reported that after implementation of the integrated specialty pharmacy service model in the VUMC ID clinic, 53% of patients had no out of pocket cost for their HCV medications. 7 In our study, there was a significant difference between the types of insurance coverage between the Pre and Post-Groups.…”

Section: Discussionmentioning

confidence: 99%

Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

et al. 2021

View full text Add to dashboard Cite

Background: Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Objectives: Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. Methods: We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). Results: The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; P < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; P < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Conclusion: Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.

show abstract

“…In a study of 388 clients who were prescribed a DAA, median time to initiate treatment when community pharmacists were involved was 4 days. In this study, pharmacists also assessed for drug-drug interactions, facilitated reimbursement, provided reminder calls to clients, and assessed weekly for adverse events (52). At present, the largest pharmacy-led initiative, the SuperDOT-C study, has recruited more than 150 clients who have been randomly assigned to traditional care pathways or pharmacyled services in 55 pharmacies in Scotland (53).…”

Section: Ost Settings and Dispensing Pharmaciesmentioning

confidence: 99%

Hepatitis C models of care: approaches to elimination

Biondi

Feld

2020

CanLivJ

View full text Add to dashboard Cite

Hepatitis C direct-acting antivirals (DAAs) have an efficacy of 95% or greater, with pangenotypic options. Many regions in Canada have recently abolished the need to demonstrate fibrosis before treatment with DAAs, and several combination therapies are available under public and private insurance coverage. As a result, efforts to increase treatment are largely focused on engaging specific populations and providers. With minimal side effects and decreased need for monitoring, hepatitis C screening, linkage, and treatment can largely be done in a single setting. In this article, we highlight both Canadian and international examples of the specialist's ongoing role and discuss the task shifting of hepatitis C treatment to primary care; specialized community clinics; and mental health, corrections, addictions, and opioid substitution therapy settings. Although specialists continue to support most models of care described in the literature, we highlight the potential for non-specialist care in working toward the elimination of hepatitis C in Canada.

show abstract

Local specialty pharmacy and specialty clinic collaboration assists access to hepatitis C direct-acting antivirals

Cited by 11 publications

References 24 publications

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

Psychosocial Obstacles to Hepatitis C Treatment Initiation Among Patients in Care: A Hitch in the Cascade of Cure

Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

Hepatitis C models of care: approaches to elimination

Contact Info

Product

Resources

About