Pharmacist-led drug therapy management for hepatitis C at a federally qualified health care center.

BACKGROUND

Chronic hepatitis C (HCV) infection is challenging to address in patients with barriers to accessing care, including those from underserved populations. Linking at-risk patients through the HCV cascade of care can address such disparities by leveraging existing patient-provider relationships to identify and treat HCV. Pharmacists are ideal clinical team members to provide direct-acting antiviral (DAA) management, given their expertise in pharmacotherapy and medication access. However, literature describing pharmacist-led DAA management at federally qualified health centers (FQHCs) is limited.

OBJECTIVE(S): To describe HCV screening, DAA prescribing and treatment initiation, post-treatment sustained virologic response (SVR) assessment, and treatment outcomes in an FQHC with pharmacist-led DAA management.

METHODS

This study describes HCV screening rates in adults with select HCV risk factors receiving primary care at a Midwest FQHC over a 4-year period. In patients with a detectible HCV viral load, DAA prescription orders for patients referred to pharmacist-led DAA management was evaluated in comparison with usual care. Treatment completion and SVR results were assessed in patients referred to pharmacists.

RESULTS

HCV screening in patients with identifiable risk factors increased from 8.0% to 67.5% over 4 years, driven by a clinical reminder for HCV screening in the birth year cohort. Of patients with positive HCV viral load results, 9.9% in the usual care group received an order for DAA therapy versus 57.1% (P < 0.001) in the pharmacist-led DAA management group. Of 162 patients referred to pharmacist-led DAA management, 61 (37.7%) initiated therapy. Of patients who initiated treatment, 57 (94.7%) had post-treatment viral load testing, with 46 (80.7% of treated patients) having SVR results and 45 (97.8% of SVR tested patients) testing negative. No usual care patients had subsequent negative HCV viral load results.

CONCLUSION

Pharmacist-led DAA management is an effective intervention to improve the treatment of patients with HCV in the FQHC setting.