Transcript Hepatitis C Treatment in the Community

Weston Outreach Clinic
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GP concern re numbers accessing tx
Patient group/local drug services pressure
Poor attendance Weston patients
Disadvantaged group poor access to transport
Nationally patients with hx IVDU prone to
DNA
Flow from diagnosis- treatment woefully
inadequate { Prof Graham Foster}
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Connects screening agency with treatment
provider
Drug workers screening patients can see the progress of people they have
identified and can discuss patients failing to engage with treatment. Provides
an incentive for drug/healthcare workers to refer.
Drug workers can more easily act as advocates for their clients with better
access to treatment provider
Treatment provider can obtain background information on
patients and identify how best to approach individual problems .
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Easy affordable access for patients without own transport avoids parking
difficulties for patients with transport
Volunteer service to give lifts for unavoidable visits
Less time consuming no need to spend large part of day waiting for or on
Public transport/navigating around Hospital [hour plus on Bus Weston
to Bristol]
Drug workers available to discuss problems and give advice on how to
explain difficulties
Specialist Nurse better placed to explain side effects / problems
associated with treatment to patients other care providers
Call from drug workers on day of appt
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HCV PCR positive patient identified by GP or
Addaction
Referral made to Hepatology BRI and appt allocated
Patient seen by specialist nurse history, blood tests,
examination carried out, fibroscan, Psychiatric referral
,USS requested as appropriate
Nurse sees patient to discuss treatment options and
review results /investigations . Any significant
problems discussed with Consultant at MDT
beforehand
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Treatment started if no significant
contraindications and patient prepared to start
Patient seen 2-4 weekly depending on response
Medication delivered to Addaction .
Supporting meds picked up from Boots
chemist nearest patient
Follow up 12 weeks and one year post tx if
successful discharge to GP
Treatment failed /patient wishes to defer
treatment reviewed 6 monthly
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Initial £12000 from local health authority to
cover set up costs
0.2 WTE Specialist Nurse initially now 0.1 WTE
due to long term sickness providing fortnightly
clinics
Liaison Psychiatry offer appointments on
request
Investigations/drug costs covered by BRI
Hepatology Dept.
Hepatology Dept. covers administrative costs
Month
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Grand Total
New Attendances
3
2
3
4
2
9
9
0
0
2
1
2
6
0
1
0
2
5
51
Follow/Up
Attendances
12
14
12
17
7
17
18
23
21
22
23
22
20
16
10
17
16
23
310
Total Attendances
15
16
15
21
9
26
27
23
21
24
24
24
26
16
11
17
18
28
361
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22 patients on current standard of care in since
April 2013 18 months
2 of the 22 dropped out of treatment
1 patient started on Expanded access programme
with Sofosbuvir
1 patient awaiting confirmation from NHS
England
1 patient died
29 deferred treatment either to wait for NICE
guidance or they preferred monitoring to
treatment
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48% of new patients seen proceeded to
treatment so double number patients referred
starting treatment
Overall DNA rate 26% difficult to compare to
previous DNA rate for Weston Patients
Figures from NHS Scotland indicate only 20%
people get as far as specialist care a quarter of
these receive treatment
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Increase frequency Weston Clinics ?
Outreach clinics in areas with high levels
HCV/deprivation remote from central
Hospitals?
Closer contacts with drug treatment Agencies
{BDP Compass Healthcare]?
Implications of high drug costs but less
significant side effects in clinic structure