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‘Building bridges’ between PCPs, liver specialists for HCV led to 100% cure

BOSTON — The Hepatitis C Leaders in Primary Care program, or HELP-C, engaged primary care physicians to successfully screen and treat veterans with hepatitis C through comanagement with a specialist liver team, according to a study presented at The Liver Meeting 2019.

“Although all veterans with hepatitis C have been offered treatment in the VA system, some have remained untreated because they did not engage with our liver clinic, despite good adherence with their primary care providers,” Susan Zapatka, a nurse practitioner codirector at the Veterans Affairs Connecticut Healthcare System, said during her presentation. “Our aim was to expand HCV treatment access and to increase birth cohort screening by empowering primary care providers to become engaged in the process.”

The HELP-C program was designed using the following resources: PCP and registered nurse training, electronic health record tools such as e-consult (Department of Veterans Affairs) and note templates with embedded order sets, data to identify PCP-specific patients requiring HCV screening or treatment, and a teleconference every 2 weeks to discuss potential patients and issues during treatment.

The program also comprised a liver support team with treating physicians, registered nurses, a clinical pharmacist and a psychologist.

“During the surge of hepatitis C treatment, the VA developed a dashboard,” Zapatka explained. “The dashboard provides an electronic database that allows us to look up patients we wanted to find for screening or treatment and electronically send alerts to our primary care providers.”

During the program, 39 HELP-C consults came into the liver clinic and 34 patients started treatment. Thirty patients completed treatment. Among the four patients who failed to complete full treatment, adherence was approximately 50% (range, 33%-83%). All patients achieved sustained virologic response for an intention-to-treat rate of 100%.

Additionally, birth cohort screening rates increased from 72.4% in 2015 before the start of the program in 2016, to 88.1% in 2019.

“This model forged partnerships with primary care providers, which will translate into effective teamwork for other liver diseases,” Zapatka said. “Building bridges between primary care providers and hepatology providers could improve the management of other liver diseases such as fatty liver and cirrhosis.” – by Talitha Bennett

Reference: Zapatka S, et al. Abstract 0206. Presented at: The Liver Meeting; Nov. 7-12, 2019; Boston.

Disclosure: Zapatka reports no relevant financial disclosures.