Integrated HCV care model appeals to hard-to-reach patients
A series of in-depth interviews with health professionals suggest that an integrated care model for hepatitis C management is able to attract and engage stigmatized patients who may be reluctant to seek treatment, researchers reported.
“Integrated service provision has been promoted as more able to flexibly and responsively meet the needs of people with chronic conditions, compared to fragmented services,” Carla Treloar, PhD, of the University of New South Wales, Sydney, and colleagues wrote in the Journal of Primary Health Care.
In 2008, the Hepatitis C Community Clinic was established in Christchurch, New Zealand. The 3-year pilot project incorporated primary care with drug treatment and HCV services. The clinic was staffed by a nurse, a social worker, a general practitioner and a receptionist. Its aim was to coordinate with patients’ general practitioners and help patients register with a general practitioner if they had not already. Located nearby was a needle exchange program to facilitate referral.
According to the researchers, funding for the clinic was extended for an additional 3 years. At the end of 2012, the clinic was servicing 718 patients, 131 of whom had been referred by the clinic for HCV treatment. Forty-three patients had started HCV treatment, 32 completed their treatment and 24 had achieved an SVR.
Treloar and colleagues conducted 24 interviews with various stakeholders to assess their experiences regarding the implementation of the clinic. These included nurses (n=7), managers (n=7), social workers (n=4), general practitioners (n=2), academics (n=2), a consultant physician (n=1) and a receptionist (n=1).
Interviewees generally endorsed the integrated care model and said it was accessible to patients, “non-judgmental,” “non-threatening,” and useful in attracting and engaging marginalized patients. Stakeholders also generally agreed that the clinic made more effective use of limited health resources, providing services that would be more expensive if handled by hospital staff, including blood tests and education about HCV infection.
However, some interviewees did not understand the role of the clinic and maintained that HCV services should be limited to the hospital setting. Others expressed concern about the potential “poaching” of patients from other health care providers, particularly from general practitioners.
According to Treloar and colleagues, the lack of understanding of the clinic’s role in treatment and concerns of poaching patients underscore the need for “knowledge brokering” through a local key opinion leader who could address these concerns and promote the successes of the clinic.
Disclosure: The researchers report no relevant financial disclosures.