Impact of Pharmacist Interventions on the Treatment of Hepatitis C Patients at a Veterans Affairs Healthcare Facility

Bennett J Doughty,Seth T Cioffi,Eric J Kuszewski

doi:10.13189/ujph.2018.060604

Abstract

Purpose: The purpose of this project is to demonstrate the impact of pharmacy interventions and interdisciplinary care on the treatment of hepatitis C virus (HCV) within the outpatient liver clinic at VA Connecticut Healthcare System (VA CT). Methods: This project consisted of a retrospective analysis of patient data conducted from 1/1/2014 – 8/1/2016 within the outpatient liver clinic at VA CT. The following information was collected and analyzed for patients referred to the clinic through the initial consult notes within the VA’s Computerized Patient Record System (CPRS): HCV genotype, human immunodeficiency virus (HIV) status, cirrhosis status, treatment history, adherence pattern per refill histories and appointment attendance, initially requested therapy, pharmacist approved therapy, drug-drug interactions (DDIs) identified by a pharmacist, and sustained viral response at 12 weeks (SVR12). Patients excluded from the above data collection included those that were not chosen to begin treatment after referral to the clinic due to issues such as significant DDIs, history of non-adherence, etc. After data collection, pharmacist recommendations were quantified over the study population and compared to the primary endpoint of SVR12 status. All data was analyzed and presented as percentages in this frequency analysis, requiring no formal statistical analysis software. Results: After comparing the initially requested regimens to those prescribed, 20% of the total 510 regimens were adjusted by a pharmacist. Changes were made for various reasons, including guideline changes, resulting labs (i.e. hemoglobin, platelets, etc.), side effects, and adherence. Approximately 73% of patients had at least one drug interaction identified. Of these identified, 31% of the interacting medications were adjusted by the provider. Finally, SVR12 status through 3/2016 was achieved in 94% of the total patient population, excluding those who did not initiate or complete therapy. Conclusion: This study concludes that the pharmacists involved in patient care within the outpatient liver clinic at VA CT have been a valuable asset to patient care and should continue to provide pharmacy services in a provider role to patients.

Highlights

The hepatitis C virus (HCV) is a contagious disease of the liver that presents either as an acute illness or a chronic disease state that affects approximately 3-4 million people in the United States, about half of which are unaware of their diagnosis
This study proves that pharmacist interventions may increase the prevalence of identifying drug-drug interactions (DDIs), selecting appropriate therapy, and increasing patient adherence, all in an effort to ascertain sustained viral response at 12 weeks (SVR12) status
VA patients pay copays on a tiered system, which limits this study’s evaluation of patient cost burden. This medication use evaluation (MUE) demonstrates that pharmacy plays an important role in the successful treatment of HCV within the outpatient liver clinic at VA Connecticut Healthcare System (VA CT)

Summary

Introduction

The hepatitis C virus (HCV) is a contagious disease of the liver that presents either as an acute illness or a chronic disease state that affects approximately 3-4 million people in the United States, about half of which are unaware of their diagnosis. Spread primarily via blood-to-blood contact, infection with HCV can lead to more complicated disease states in approximately 75% of patients, including hepatocellular carcinoma and cirrhosis [1]. Current data suggests that veterans are at an increased risk when contrasted to the general population [2, 3]. HCV is further characterized into six genotypes, of which the most common is genotype 1. Genotype 1 is further subdivided into genotypes 1a and 1b, with genotype 1a proving to generally be more resistant to treatment in recent trials. When no subclass can be determined, genotype 1 patients are treated as though they have genotype 1a [4]

Results

Discussion

Conclusion