In the JournalsPerspective

Collaborations between rural clinics, pharmacists provide ‘excellent’ HCV outcomes

Collaborative practice agreements between pharmacists and rural clinics that targeted American Indian/Alaska Native populations led to successful outcomes for patients with hepatitis C virus, according to findings recently published in the Journal of Primary Care and Community Health.

Rebecca Geiger, PharmD, MHA, BCACP, of the Indian Health Service in Lawton, Oklahoma, and colleagues gathered patient data from 11 health facilities that serve American Indian/Alaska Natives with HCV. According to researchers, many of these locations are rural and understaffed.

These clinics allowed a pharmacist — under a physician’s supervision — to place laboratory orders, choose medication regimens and therapy duration, manage medication procurement and adverse events, provide thorough medication counseling and identify prescription and over-the-counter drug interactions that could potentially increase treatment adherence and cure. In some instances, the pharmacist also connected patients with other HCV-related services.

Geiger and colleagues found that of the 1,789 patients with HCV-positive antibodies, 1,381 had a confirmation test. Of the 929 who tested positive in this second test, 576 had liver fibrosis scored and 335 had initiated treatment. In addition, all 274 patients who took a sustained virologic response/cure test received negative results.

“These data did not seek to track default or treatment failures, and likely overestimate true [sustained virologic response] rates as complicated patients may be referred to external specialists, although treatment outcomes are still thought to be excellent,” researchers wrote.

“These data indicate that rural clinics using collaborative practice agreements with pharmacists can be instrumental in HCV services at the primary care level and have strong outcomes in HCV treatment/sustained virologic response at 12 months,” they added.

Geiger and colleagues cautioned local barriers may hinder broad replication of their findings. They also suggested future research address obstacles that cause patients to be lost to follow-up, such as stigma, transportation, costs or efficacy of treatment. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

 

Collaborative practice agreements between pharmacists and rural clinics that targeted American Indian/Alaska Native populations led to successful outcomes for patients with hepatitis C virus, according to findings recently published in the Journal of Primary Care and Community Health.

Rebecca Geiger, PharmD, MHA, BCACP, of the Indian Health Service in Lawton, Oklahoma, and colleagues gathered patient data from 11 health facilities that serve American Indian/Alaska Natives with HCV. According to researchers, many of these locations are rural and understaffed.

These clinics allowed a pharmacist — under a physician’s supervision — to place laboratory orders, choose medication regimens and therapy duration, manage medication procurement and adverse events, provide thorough medication counseling and identify prescription and over-the-counter drug interactions that could potentially increase treatment adherence and cure. In some instances, the pharmacist also connected patients with other HCV-related services.

Geiger and colleagues found that of the 1,789 patients with HCV-positive antibodies, 1,381 had a confirmation test. Of the 929 who tested positive in this second test, 576 had liver fibrosis scored and 335 had initiated treatment. In addition, all 274 patients who took a sustained virologic response/cure test received negative results.

“These data did not seek to track default or treatment failures, and likely overestimate true [sustained virologic response] rates as complicated patients may be referred to external specialists, although treatment outcomes are still thought to be excellent,” researchers wrote.

“These data indicate that rural clinics using collaborative practice agreements with pharmacists can be instrumental in HCV services at the primary care level and have strong outcomes in HCV treatment/sustained virologic response at 12 months,” they added.

Geiger and colleagues cautioned local barriers may hinder broad replication of their findings. They also suggested future research address obstacles that cause patients to be lost to follow-up, such as stigma, transportation, costs or efficacy of treatment. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

 

    Perspective
    C. Michael White

    C. Michael White

    Ensuring that the at-risk population for the hepatitis C virus is screened, that those with HCV initiate treatment, and that they then continue care until they are cured is vitally important.

    This study shows quite elegantly that pharmacists are uniquely positioned to take on these tasks, especially in underserved areas of the country like Indian reservations. The presence of a pharmacist to provide medication-related clinical services is a vital link in the health care system.

    As identified in the Surgeon General’s 2011 report on the profession of pharmacy titled “Improving patient and health system outcomes through advanced pharmacy practice,” inpatient rounding with the health care team, ensuring medication adherence, providing medication therapy management, antimicrobial stewardship, and overseeing medication specialty clinics (hypertension, anticoagulation, primary care, hematocrit/iron, diabetes, etc.) play into the strengths of the pharmacist while not taking away work from other practitioners. These services can usually be provided with no additional cost or yielding cost savings to the health care system and allow other health professionals to improve the efficiency of the care they provide by relegating labor-intensive medication-related counseling and medication reinforcement to the pharmacist. Pharmacy practices in inpatient settings and federal health care outpatient settings attest to the value of these pharmacy services.

    Unfortunately, nonfederal practices that want pharmacists to collaborate with them are stymied because pharmacists are not recognized as Medicare Part B providers and have difficulty billing for services. Nonfederal health systems struggle financially to include pharmacists even though the providers desire their contributions immensely. In the new primary care reality, where practices are held accountable for performance and quality measures, the pharmacist is a tremendous weapon to turn the tide, but we need to change the antiquated billing system.

    References:

    Giberson S, et al. “Improving patient and health system outcomes through advanced pharmacy practice. A report to the U.S. surgeon general. Office of the chief pharmacist.” https://www.accp.com/docs/positions/misc/improving_patient_and_health_system_outcomes.pdf. December 2011.

    White CM. Ann Pharmacother. 2014;doi:10.1177/1060028013511786.

    • C. Michael White, PharmD, FCP, FCCP
    • department of pharmacy practice, University of Connecticut

    Disclosures: White reports no relevant financial disclosures.