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Pharmacist-driven HCV treatment model yields high SVR rates
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Clinical pharmacist-delivered hepatitis C virus therapy yields high rates of SVR, according to findings published in Open Forum Infectious Diseases.
“In order to meet national hepatitis C elimination goals, expansions of the care team and innovations in care delivery are needed,” David Koren, PharmD, BCPS, AAHIVP, clinical pharmacy specialist in infectious diseases at Temple University Hospital, told Infectious Disease News. “Through the usage of collaborative practice agreements, clinical pharmacists are effective to drive and deliver hepatitis C treatment.”
Koren and colleagues explained that previous research has demonstrated the success of including mid-level providers and nonspecialist primary care providers in the HCV treatment workforce, but evidence demonstrating the effectiveness of a clinical pharmacist-driven HCV delivery model in an open medical system has not yet been documented.
They conducted a multicenter retrospective cohort study that included 1,253 patients who initiated direct-acting antivirals (DAAs) between Jan. 1, 2014, and March 12, 2018, at four participating institutions: Creighton University, Temple University Health System, University of Illinois Hospital and Health Sciences System and Vanderbilt University Medical Center.
Of the patients who initiated treatment, 95 were lost to follow up and 24 discontinued therapy. The primary outcome was SVR, analyzed for patients who initiated treatment (the intent-to-treat population) and those who completed treatment (the per-protocol population).
The mean age of patients was 57.4 years, 63.9% were male, 53.7% were black, 40.3% were cirrhotic, 88.4% had HCV genotype 1 and 81.6% were treatment-naive, the researchers reported.
According to the study, 95.1% of patients in the per-protocol population demonstrated SVR, whereas 86.1% of the intent-to-treat population demonstrated SVR. Patients who missed one or more treatment doses had an SVR of 74.9%, whereas those with full adherence had an SVR of 90% (P < .0001), Koren and colleagues noted.
They underscored that this was the first study to demonstrate the efficacy of using such a model across multiple institutions that serve a large and diverse patient population.
“The multi-site nature of the study as well as inclusion of complex patient groups demonstrate reproducibility and validate that clinical pharmacists can provide successful hepatitis C treatment to a variety of patients when delivered as part of an interdisciplinary, collaborative team,” Koren said. – by Marley Ghizzone
Disclosures: Koren reports receiving research funding from Gilead Sciences and serving on an advisory board for Gilead Sciences and ViiV Healthcare. Please see the study for all other authors relevant financial disclosures.
Perspective
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Robin Bricker-Ford, PharmD, BCIDP, BCPS, AAHIV
I anticipate that this article will be one of many to highlight the established success and future potential of pharmacist-driven practice models in patient care. It is encouraging to see the pharmacists’ role expand beyond medication management to encompass a comprehensive HCV management approach. Although it comes as no surprise to me, the results of this study indicate that with adequate training, pharmacists can achieve the same level of expertise and are held to the same standard as other hepatology practitioners. It is clear that with the in-depth knowledge of medication pharmacokinetics, drug-drug interactions and adverse effects related to drug therapy, pharmacists are equipped to determine an appropriate treatment regimen, devise a monitoring plan, order required laboratory tests and provide patient education that is essential for effective HCV treatment. Based on this information, health care system administrators should strive to implement pharmacist-run HCV clinics nationwide to increase the quantity and quality of patient care. In fact, I foresee that the future of HCV management will expand outside of the clinic setting using pharmacist-directed telemedicine. This approach can help to alleviate linkage-to-care barriers for patients who live in rural areas and do not have access to a specialist. Using pharmacists in these practice care settings is a vital step toward accomplishing the global WHO HCV elimination goals in the next decade. I cannot stress enough that this is a crucial time for pharmacists to take a leading role in HCV management and advocate for advancing clinical authority.
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