Integrating Hepatitis C Treatment in Primary Care

1. Integrating Hepatitis C Treatment in Primary Care D Swan, G McCombe, E O’Connor, C Murphy, G Avramovic, J Macias, J Surey, C Oprea, P Vickerman, Z Ward, JS Lambert, W Cullen School of Medicine, University College Dublin, Ireland

2. Acknowledgements • Co-funded by European Commission through its EU Third Health Programme and Ireland’s Health Services Executive • Participating GPs and patients • Our partners: UCL, U Bristol, SAS Seville Website:http://www.ucd.ie/medicine/hepcare/

3. Aims • To describe integrated model of HCV care and its implementation in practice • To examine current HCV care practice Website:http://www.ucd.ie/medicine/hepcare/

4. Aims • To describe integrated model of HCV care and its implementation in practice • To examine current HCV care practice Website:http://www.ucd.ie/medicine/hepcare/

5. Does primary care have a role? “we see it in the faces and stories of our patients”

6. Introduction Arora et al, NEJM, 2011; Swan et al, AIDS Patient Care and STDs, 2010; Cullen et al, BJGP, 2006. • Injecting drug use main route of transmission globally • Complex barriers mean few have received HCV treatment • HCV infection treatment in primary care now feasible, acceptable…. • In Ireland and the EU, primary care is increasingly providing long-term care for people who inject drugs (62-81% are infected with HCV) • So…?

7. Assess HCV status Advise on safe drug use, transmission Assess other bloodborne viruses too Refer to clinic for evaluation / treatment Address lifestyle / psychosocial issues Immunise (HBV, HAV) Provide ongoing psychosocial support Review / monitor for liver disease Provide continuing, holistic care Barry et al, IJMS, 2004 & HSE Hepatitis C Strategy, 2014 Cullen et al, Ir J Med Sci, 2004

8. Implementation Clinical guidelines + education + referral resources + nurse support Cullen et al, BJGP, 2006

9. Heplink Objectives To improve HCV care outcomes among patients receiving OST in general practice, by: - developing integrated model of HCV care - evaluating feasibility, acceptability and likely efficacy

10. Integrated Care • ‘…a worldwide trend in health care reforms focusing on more coordinated forms of care provision…may be seen as a response to the fragmented delivery of health and social services … in many health systems • WHO gives the following definition: "a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency”’

11. Integrated Care – Hepatitis C Education of community practitioners Outreach of HCV trained nurse into GP practices Enhanced access to community-based HCV evaluation (including fibroscan)

12. Methods: Recruitment & Data collection • GP practices eligible if: • OST prescribing • Catchment area of MMUH • Patients eligible if: • ≥ 18 years of age • on OST • attend the practice for any reason during the recruitment period • Baseline data on HCV care processes / outcomes extracted from the clinical records of participating patients

13. GP Practices recruited n=14 Patients recruited n=135 Baseline Data Collected n=134

18. Results: Fibroscan

19. …and beyond

20. …and beyond

21. Discussion Most screened, access to specialist assessment / treatment a challenge (47% and 15% respectively) Prevalence of cirrhosis high Alcohol screening low! Feasible, acceptable, but effectiveness? Need for definitive intervention

22. Thank you • Email: Walter.cullen@ucd.ie Website:http://www.ucd.ie/medicine/hepcare/