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2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic

BACKGROUND: Direct-acting antivirals (DAAs) have changed the paradigm of HCV treatment due to high-sustained virologic response (SVR) rates and minimal adverse events. Prior authorizations, complex treatment criteria, and inadequate clinic staffing to meet demands of screening efforts may prevent ac...

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Autores principales: Vibhakar, Sonia, Nowicki, Diana, Huhn, Greg, Goldberg, Rebecca, Adeyemi, Oluwatoyin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252939/
http://dx.doi.org/10.1093/ofid/ofy210.1888
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author Vibhakar, Sonia
Nowicki, Diana
Huhn, Greg
Goldberg, Rebecca
Adeyemi, Oluwatoyin
author_facet Vibhakar, Sonia
Nowicki, Diana
Huhn, Greg
Goldberg, Rebecca
Adeyemi, Oluwatoyin
author_sort Vibhakar, Sonia
collection PubMed
description BACKGROUND: Direct-acting antivirals (DAAs) have changed the paradigm of HCV treatment due to high-sustained virologic response (SVR) rates and minimal adverse events. Prior authorizations, complex treatment criteria, and inadequate clinic staffing to meet demands of screening efforts may prevent access to treatment. Recent literature suggests that pharmacist involvement in HCV treatment can optimize care. We present a clinic protocol with collaborative drug therapy management to alleviate HCV treatment burdens. METHODS: A retrospective review of patients referred and evaluated for HCV treatment between February 2014 and April 2018 at the Ruth M. Rothstein CORE Center. Exclusion was no SVR12 data. Demographic data along with HCV RNA at Week 4, end of treatment, and 12 weeks thereafter were collected. RESULTS: Of 682 treatment referrals, 76 patients were denied or ineligible, two referred to study, and six not treated (lost to care, incarceration, or death). Of the 598 patients treated, complete data were available for 430. Of the remaining 168 patients, 72% have upcoming appts, 26% lost to follow-up, and 2% died. Mean age was 57.6 years (range 22–82), 70.5% male, 67% black, 17.2% Hispanic, 12.8% White; 203 were (47.2%) HCV/HIV co-infected. Majority were treatment naïve (86.3%) and cirrhotic (42.1%) with a median Fibro Scan of 13 (range 3.4–75). Most patients received ledipasvir/sofosbuvir (70%). Overall SVR rate was 93.5% (402/430); HIV co-infected patients 94.6% (192/203) and mono-infected patients 92.5% (210/227). CONCLUSION: A collaborative approach in HCV treatment allows us to overcome adherence barriers such as health literacy, medication acquisition issues, and drug interactions, as well as increase clinic productivity. A retrospective study may not capture all pharmacist interventions that prevent lapses in therapy such as frequent pharmacy calls and insurance resolution. However, this study shows that with an established clinic protocol and support of a multi-disciplinary team, high SVR rates are maintained, even in the large proportion of cirrhotic patients in our cohort. As clinic referrals continue to grow, additional staff may further support organizational work flow. [Image: see text] [Image: see text] DISCLOSURES: G. Huhn, Gilead: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; ViiV Healthcare: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Theratechnologies: Scientific Advisor, Consulting fee; Proteus: Grant Investigator, Grant recipient.
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spelling pubmed-62529392018-11-28 2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic Vibhakar, Sonia Nowicki, Diana Huhn, Greg Goldberg, Rebecca Adeyemi, Oluwatoyin Open Forum Infect Dis Abstracts BACKGROUND: Direct-acting antivirals (DAAs) have changed the paradigm of HCV treatment due to high-sustained virologic response (SVR) rates and minimal adverse events. Prior authorizations, complex treatment criteria, and inadequate clinic staffing to meet demands of screening efforts may prevent access to treatment. Recent literature suggests that pharmacist involvement in HCV treatment can optimize care. We present a clinic protocol with collaborative drug therapy management to alleviate HCV treatment burdens. METHODS: A retrospective review of patients referred and evaluated for HCV treatment between February 2014 and April 2018 at the Ruth M. Rothstein CORE Center. Exclusion was no SVR12 data. Demographic data along with HCV RNA at Week 4, end of treatment, and 12 weeks thereafter were collected. RESULTS: Of 682 treatment referrals, 76 patients were denied or ineligible, two referred to study, and six not treated (lost to care, incarceration, or death). Of the 598 patients treated, complete data were available for 430. Of the remaining 168 patients, 72% have upcoming appts, 26% lost to follow-up, and 2% died. Mean age was 57.6 years (range 22–82), 70.5% male, 67% black, 17.2% Hispanic, 12.8% White; 203 were (47.2%) HCV/HIV co-infected. Majority were treatment naïve (86.3%) and cirrhotic (42.1%) with a median Fibro Scan of 13 (range 3.4–75). Most patients received ledipasvir/sofosbuvir (70%). Overall SVR rate was 93.5% (402/430); HIV co-infected patients 94.6% (192/203) and mono-infected patients 92.5% (210/227). CONCLUSION: A collaborative approach in HCV treatment allows us to overcome adherence barriers such as health literacy, medication acquisition issues, and drug interactions, as well as increase clinic productivity. A retrospective study may not capture all pharmacist interventions that prevent lapses in therapy such as frequent pharmacy calls and insurance resolution. However, this study shows that with an established clinic protocol and support of a multi-disciplinary team, high SVR rates are maintained, even in the large proportion of cirrhotic patients in our cohort. As clinic referrals continue to grow, additional staff may further support organizational work flow. [Image: see text] [Image: see text] DISCLOSURES: G. Huhn, Gilead: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; ViiV Healthcare: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Theratechnologies: Scientific Advisor, Consulting fee; Proteus: Grant Investigator, Grant recipient. Oxford University Press 2018-11-26 /pmc/articles/PMC6252939/ http://dx.doi.org/10.1093/ofid/ofy210.1888 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Vibhakar, Sonia
Nowicki, Diana
Huhn, Greg
Goldberg, Rebecca
Adeyemi, Oluwatoyin
2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic
title 2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic
title_full 2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic
title_fullStr 2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic
title_full_unstemmed 2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic
title_short 2235. A Collaborative Drug Therapy Management Model for the Treatment of Hepatitis C Virus (HCV) in an Urban Clinic
title_sort 2235. a collaborative drug therapy management model for the treatment of hepatitis c virus (hcv) in an urban clinic
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252939/
http://dx.doi.org/10.1093/ofid/ofy210.1888
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