HepC Break Through project

Transcription

1 Improving Mental Health by Sharing Knowledge HepC Break Through project A long story with a happy ending Esther Croes MD PhD

2 DRID situationin the NL ~ 14,000 problematic opiate users (current); 70% in contact with addiction care?? Ever opiate injectors;?? current crack cocaïne users ~ 1000 current injectors HIV HepB HepC Prevalence* Low - medium (<0.1 10%) Low (<5%) High (30-80%) Diagnosed High Medium Low In treatment/ in followup High Medium Low *estimates! 2

3 DRID situationin the NL ~ 14,000 problematic opiate users (current); 70% in contact with addiction care?? Ever opiate injectors;?? current crack cocaïne users ~ 1000 current injectors HIV HepB HepC Prevalence* Low - medium (<0.1 10%) Low (<5%) High (30-80%) Diagnosed High Medium Low In treatment/ in followup High Medium Low C/ HepC is the biggest challenge *estimates! 3

4 Initial answer to the hepc challenge 2009/2010: national HCV information campaign, with a sub-campaign targeting drug users IF drug users were reached, the campaign was effective: Knowledge about HCV increased Uptake of screening and treatment improved BUT: far majority of drug users were not reached, due to a low level of implementation Many many many barriers for implementation: hepc has no priority in addiction care hepc is not a task for addiction care Years of monitoring: Highnumber of undiagnosed and untreated HCV patients in addiction care Promising developments in medication Several local(small) examples of good practice Screening is cost-effective 4

5 The pragmatic answer: Break Through Often used implementation method, based on PDCA cycle Aim: to realise concrete changes in care within a short period of time, recognising local differences Here: resulting in local HepC care pathways (who is when responsible for what), embedded in daily practice (protocols) SMART goals and use of indicators to monitor results Local multi-disciplinary teams exchange experience and knowledge in (four) conference days Experts guide and visit local teams Central coordinators facilitate with toolkits, training, teamsite (internet), etc 5

6 Recruitment of 10 local teams From 4 of 11 organisations for addiction care Team members (minimum): addiction care (MMP or HAT): specialised nurse + MD + manager general hospital (gastroenterology or infectiology): hepatitis nurse + specialist MD Needed: 1 local project leader Commitment from management (hours, mental support) Willingness to embed the care path permanently 1.5 years time ( quiet period ) Think big, but start small! Start with few AC locations and hospitals and scale up when it works 6

7 Practice-based project Identification of problems (some examples): No contact between hospital and addiction care How to seduce patients How to diminish the threshold for patients to hospital Design project plan and test the plan in PDCA-cycles Working conferences for exchange with other teams A separate conference for managers of participating teams Solutions (some examples): Seducing patients with small incentives Testing with swabs or one venapuncture and test in phases (store blood) Counselling and information hours by nurses of AC and hospital together Use photos in information leaflet for patients Always psychiatric advice and always attention for birth control Share results with management regularly Monitor progress and visualise it (coloured excel) Ask for informed consent (to communicate to all relevant MDs) at the start 7

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9 The project in a glance 9

10 Success factors An implementation method suitable for the problem (changing work processes requires expertise) Enthusiastic and multidisciplinary teams Teams were supported with tools and advice, but not financially (sustainability after ending of the project) Special attention to management Simple and convincing message about relevance hepc Excellent expert panel 10

11 Success factor message Simple and convincing message about relevance hepc Remember the arguments: hepc has no priority in addiction care hepc is not a task for addiction care 11

12 No priority 600 Mortality HIV in NL daeths / year HIV Central Bureau for Statistics, Made by 12

13 No priority Mortality hepb& C in NL deaths / year HBV-HCV Central Bureau for Statistics, Made by 13

14 Priority: our challenge deaths / year HepB&C deaths HBV-HCV HIV year Central Bureau for Statistics, Made by 14

15 High fruit HepC no task for addiction care MSM 5% hemofilie pt 2% Low risk groups 25% First generation migrants 41% DU and IDU 27% Pickable fruit Total N = 30,000 Low fruit Based on Urbanus et al, 2012; and Vriend et al, 2012

16 The importance of addiction care Medical specialist is responsible for treatment, but support from AC is essential in all phases: Case finding: Workers in AC know of the patient s risk behavior Active testing enhances case finding (Helsper 2011, Singels 2010) Preparation for HCV treatment: Working towards HCV treatment: stability in drug use, stable living conditions and co-morbidity Guidance/support during treatment: Expertise in venapuncture, motivational interviewing, medication management, hospitalisation when needed, knowledge of specific addiction problems Aftercare: Consolidation of positive results in various areas: a new start 16

17 Success factor expert team 17

18 Impact Participating teams: 1 organisation of AC was completely covered in this project 1 organisation has officially adopted hepatitis screening in their infectious disease protocol: other locations will adopt the care path 1 organisation is organising with all hospitals in the region the care path Cooperation is on more that hepatitis: Now I know how to find addiction care for e.g., my alcoholic liver patients Dissemination of the best practices Break Through 2 is financed and recruitment of new teams is ongoing Website with best practices and other information Political awareness The project is mentioned as good example in several letters of the MoH Expertise used in National Hepatitis Steering Group and Dutch Health Council advising on hepatitis screening Working visits for policy makers and politicians 18

19 Lessons learned Improving HCV care takes a long breath Sitting at our desk, we do not realise what the daily problems are; they are far more simple / far more complicated that we could ever imagine Don t impose a fixed blue print, but support local solutions 19

20 More? EU Call : improving access to hepatitis care, based on knowlegde and experience from Break Through project. 3-4 countries, each with central coordinator and 8-10 teams Fitting with local needs and possibilities Possibility to extend to hepb or other risk groups/ settings Making use of modern conference techniques (e.g., video conferencing) Include modelling/ cost-effectiveness study? Interested? Contact: Esther Croes ecroes@trimbos.nl 20