Primary care pharmacists successfully manage uncomplicated HCV cases

WASHINGTON — Utilizing existing primary care pharmacists allowed for an increased number of patients treated with comparable results to liver specialists, according to a presenter at The Liver Meeting 2017.

“Primary care pharmacists can effectively manage patients with uncomplicated HCV infection after treatment evaluation and initiation by a liver pharmacist,” Macy Ho, PharmD, from the VA Long Beach Healthcare System, said in her presentation. “There was no difference in patient outcomes.”

Ho explained that she and another liver clinical pharmacist specialist trained 13 primary care pharmacists to be part of the patient-aligned care team (PACT) using both training sessions and shadowing at a hepatitis C clinic.

They then identified patients within the system who had HCV and conducted specialist-driven evaluations. The clinical pharmacist liver specialist conducted a full work-up of all patients and assisted in choosing their DAA regimen. Patients with genotypes 2, 3 and 4 and those with complications such as cirrhosis maintained their care with the clinical pharmacist specialist or hepatologist. All genotype 1, uncomplicated patients treated with non-ribavirin regimens were referred to the PACT.

In 2016, Ho and colleagues studied 138 patients with genotype 1 treated with DAA monotherapy. Of these, 64 received a referral to the primary care pharmacists while the liver pharmacist followed 74 patients, including more with cirrhosis.

“It requires the cooperation and support from many people,” Ho said. She and another clinical pharmacist specialist were available for easy reference. “This gave the primary care pharmacists a lot of confidence.”

Ho said that two patients under primary care discontinued while three under the liver specialists did the same and a comparable number were lost to follow-up.

Of the 52 patients under primary care management who completed follow-up an had sustained virologic response load tests, only one failed to achieve SVR12, leaving them at a 98% rate of SVR. In the liver specialist group, all 62 with measurable viral loads achieved SVR12, leaving them at 100%.

Ho reported that the Long Beach VA has tested 89% of the patients in the birth cohort: “With availability of the DAAs, more patients are eligible and will be treated.”

She said access to liver specialist pharmacists and/or hepatologists is crucial for success of programs like this one, especially as they start out.

“In the end, health care systems, HMOs, health care systems like the VA, we can treat greater numbers of HCV patients with existing resources by utilizing the pharmacists and primary care,” Ho said. “We treated a lot of patients without having to hire any more pharmacists. There were no delays in starting treatment. We want to treat patients and get them into clinic as soon as they say yes.” – by Katrina Altersitz

Reference:

Ho M, et al. Abstract 21. Presented at: The Liver Meeting; Oct. 20-24, 2017; Washington, D.C.

Disclosure: Ho reports no relevant financial disclosures.