Cambridge Health Alliance (CHA): HCV Treatment Readiness. SPNS grantee meeting March 20, 2013

Transcription

1 Cambridge Health Alliance (CHA): HCV Treatment Readiness SPNS grantee meeting March 20, 2013

2 Cambridge Health Alliance Zinberg Clinic: Comprehensive primary and specialty care services ~300 HIV+ patients, ~400 total patients Somerville Hospital Primary Care (SHPC) Integrated HIV clinic with HIV specialty team ~143 patients Multidisciplinary approach Includes primary care, specialty care, mental health and social services (including case management), acupuncture Providers include: physicians, NPs, RNs, social workers, etc.

3 Demographics 443 total HIV patients (SHPC and Zinberg combined) 33% white, 33% black, 31% Hispanic 70% born outside of US 73% have history of or have active mental illness 20% with active substance abuse 18% coinfected with HIV/HCV (80 patients)

4 SPNS grant goals Establish systems for Identifying and screening high risk patients for hepatitis C annually Designing and implementing a plan for outreach and education about HCV treatment to HIV/HCV co infected patients Developing and implementing an innovative HCV treatment program within a comprehensive continuum of quality HIV primary care and services

5 Multidisciplinary HCV committee HIV Program Director Medical Director Planned Care Coordinator RN Nurse Medical Case Manager Manager of HIV Social Work Services HCV Coordinator/Health Educator Data/Evaluation Managers Clinic Nurse Manager Nurse Practitioners

6 Focus area: HCV treatment readiness Needs assessment: interviews with providers and staff Goal: Identify intervening variables that might be barriers to HIV/HCV patients receiving, adhering to, or completing HCV treatment Intervention: Hepatitis C educational sessions Goal: Evaluate, teach and assess patients knowledge of hepatitis C, treatment, concerns, and readiness

7 Needs assessment: Staff interviews Methods: Interviews with six providers and staff from Zinberg Clinic and SHPC Interviewees were identified by HCV Committee Interviewees represented a range of roles in caring for HIV/HCV co-infected patients, including nursing, case management, and infectious disease

8 Needs assessment results Barriers to HCV treatment Fear of side effects (physical, mental, and emotional) Mental health assessment requirement Misinformation shared among patients Number of required clinic visits Health insurance issues Homelessness Structural barriers at the clinic (funding, staffing, multilingual personnel, time)

9 Needs assessment results Helping patients get ready for treatment Assisting patients to make the decision to start treatment is critical Discussions tend to focus on negative aspects of treatment Need to change to more positive messaging emphasizing benefits of treatment Providers could use training on interviewing To encourage patient interest and involvement, patients should be invited to review proposed treatment plans with providers

10 HCV educational sessions Methods: HCV Committee identified patients to invite to participate in educational sessions Two separate educational sessions 24 total participants (five attended both sessions) Topics covered: hepatitis basics, HIV/HCV co infection, stages of liver damage, biopsy, treatment, explanation of terms Second session included a panel of patients who had experienced HCV treatment Participants completed a survey before and after attending an educational session

11 Educational sessions: survey results 95.8% of participants rated the educational sessions as either Excellent or Good 62.5% of those who heard the patient panel said that hearing from peers increased their interest in treatment* *Only asked in survey for second educational session

12 Educational sessions: survey results What was useful about hearing from peers?* Learning ways of dealing with side effects Hearing about successful treatments Being supportive of each other Hearing different reactions of the peers Knowing you aren t alone *Only asked in survey for second educational session

13 Survey results: knowledge Knowlege of the Liver and its Functions (N=24) 100.0% 80.0% 60.0% 58.3% 54.2% Very Little Some Quite a lot A great deal Percent rating knowledge of liver and its functions as Quite a lot or A great deal : 29.2% before session 40.0% 79.2% after session 29.2% 25.0% 20.0% 12.5% 16.7% 0.0% 0.0% Before the Session 4.2% After the Session Not shown: % missing response

14 Survey results: knowledge Knowlege of Hepatitis C and its Effect on the Liver (N=24) 100.0% 80.0% 60.0% Very Little Some Quite a lot A great deal Percent rating knowledge of HepC and its effect on the liver as Quite a lot or A great deal : 40.0% 33.3% 33.3% 41.7% 39.2% 53.3% before session 80.9% after session 20.0% 12.5% 20.0% 20.0% 0.0% Before the Session 0.0% After the Session Not shown: % missing response

15 Survey results: knowledge Knowlege of Hepatitis C Treatment (N=24) 100.0% 80.0% 60.0% 50.0% Very Little Some Quite a lot A great deal Percent rating knowledge of HepC treatment as Quite a lot or A great deal : 50.0% before session 40.0% 37.5% 33.3% 83.3% after session 25% 25% 20.0% 12.5% 8% 4% 0.0% Before the Session After the Session Not shown: % missing response

16 Survey results: beliefs and self-efficacy I feel ready to discuss Hepatits C with my provider (N=24) 100% 80% Strongly Disagree Disagree Agree Strongly Agree Percent answering Agree or Strongly Agree : 60% 50.0% 50.0% 70.0% before session 83.3% after session 40% 33.3% 20% 12.5% 20.0% 8.3% 0% 0.0% 0.0% Before the Session After the Session Not shown: % missing response

17 Survey results: beliefs and self-efficacy I believe that Hepatitis C treatment will work (N=24) 100% 80% Strongly Disagree Disagree Agree Strongly Agree Percent answering Agree or Strongly Agree : 60% 54.2% before session 66.7% after session 40% 37.5% 20% 29.2% 25.0% 20.0% 29.2% 0% 0.0% Before the Session 8.3% 4.2% After the Session Not shown: % missing response

18 Survey results: beliefs and self-efficacy I feel ready to start treatment for Hepatitis C (N=24) % 80.00% 60.00% 40.00% Strongly Disagree Disagree Agree Strongly Agree Percent answering Agree or Strongly Agree : 32.5% before session 45.9% after session 20.00% 29.2% 25.0% 25.0% 20.0% 16.7% 16.7% 12.5% 8.3% 0.00% Before the Session After the Session Not shown: % missing response

19 Survey results: beliefs and self-efficacy I am concerned that Hepatitis C treatment may affect my HIV (N=16) 100% 80% Strongly Disagree Disagree Agree Strongly Agree Percent answering Agree or Strongly Agree : 60% 49.8% before session 40% 31.3% 31.3% 37.5% 63.0% after session 25.0% 20% 18.8% 18.8% 0% 0.0% 0.0% Before the Session After the Session Question only asked in survey for first educational session Not shown: % missing response

20 Survey results: concerns about treatment Concerns of Hepatitis C Treatment (N=24) 80.0% 70.0% 60.0% 62.5% 50.0% 40.0% 30.0% 20.0% 45.8% 45.8% 41.7% 37.5% 29.2% 29.2% 20.8% 20.8% 10.0% 0.0% Physical side effects Number of medications Emotional side effects Number of clinic visits Number of blood draws Inability to work/care for family Giving myself shots Relapsing into drug/alcohol abuse Lack of support from family/friends

21 Conclusions Participation in SPNS grant has allowed us to expand capacity to treat HIV /Hep C coinfected as well as HCV mono infected patients. Created systems for treatment including - templates for facilitating assessment of treatment readiness, patient education talking points, and process for getting Prior Authorization for medications HCV treatment will continue beyond the funded period. Services are reimbursable by third party insurances including the State s Mass Health Program.