Public Health Detailing as a Strategy to Increase Hepatitis Testing

Transcription

1 Table Header Public Health Detailing as a Strategy to Increase Hepatitis Testing HepatitisTesting Partnership Webinar 4 January 16, 2018

2 Hepatitis Testing Partnership Welcome to the fourth webinar of the Hepatitis Testing Partnership! A diverse coalition of stakeholders working together to increase testing and linkage to care for hepatitis B and C Convenes through a listserv and quarterly webinars to share ideas, lessons learned, resources, and best practices 2

3 Public Health Detailing as a Strategy to Increase Hepatitis Testing Overview of Public Health Detailing and NACCHO s Hepatitis C Public Health Detailing Kit Gretchen Weiss Director, HIV, STI, and Viral Hepatitis January 16, 2018

4 Public Health Detailing Strategy to educate providers and deliver key public health messages using tailored and brief visits and sharing tools and resources to support uptake of clinical recommendations and best practices Goal of increasing provider capacity to meet patient and community needs through the delivery of necessary clinical and preventive services Healthcare providers and office staff have been receptive to detailing efforts and providers report greater adherence to clinical practice guidelines and wide distribution of patient-directed educational resources following detailing visits 1, 2 Supports relationship development between the health department and community providers 1 Larson, et al. (2006). Public Health Detailing: A strategy to Improve the Delivery of Clinical Preventive Services in New York City. Public Health Reports, 121, Dresser, et al. (2012). Public Health Detailing of Primary Care Providers: New York City s Experience, American Journal of Preventive Medicine, 42(6), S

5 NACCHO s Hepatitis C Public Health Detailing Kit Developed to support local health department implementation of public health detailing as a healthcare provider education strategy The kit contains: Ø User s guide Ø Tools for healthcare provider education Ø Leave-behind tools and resources for healthcare providers Ø Leave-behind materials for patient education Available online at

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7 Components of Public Health Detailing Presentation on topic Kits/leave-behinds Detailer training Practice/provider identification Visits Follow-up Evaluation

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11 Thank you Gretchen Weiss, MPH Director of HIV, STI, and Viral Hepatitis National Association of County and City Health Officials Hepatitis C Public Health Detailing Kit Hepatitis C and Local Health Departments Educational Series

12 HCV Detailing Kit

13 Disclosures The presenters have no relevant commercial interests to disclose. Use of trade names and commercial sources is for identification only and does not imply endorsement by the Washington State Department of Health

14 Epidemiologic profile of hepatitis C in Washington Full document available at: DataandStatisticalReports/ DiseasesandChronicConditions/ ChronicHepatitisSurveillance Please give us feedback on the profile by taking a short survey: opinio/s?s=hcvepiprofile

15 Epidemiologic profile of hepatitis C in Utilization, Dissemination and Evaluation Conducted 21 presentations In-person presentations reached over 400 providers / hospital administrators / public health stakeholders Formative & Outcome evaluation methods Washington

16 Epidemiological Profile Presentations Epi data trends Focus on disproportionately affected populations Diagnostics Current treatment and management Medicaid polices Case intervention Public Health recommendations

17 Public Health Recommendations Identify people with hepatitis C, link them to care and get them to a cure Build a health care workforce prepared to diagnose, care for, treat, and cure people infected with hepatitis C Educate communities about risk factors for hepatitis C, how to reduce risk, and the availability of prevention, testing, and treatment services Improve testing, care, and treatment to raise the bars along the continuum What is needed to accomplish this?

18 What did We Hear? Overwhelming support to do something, but. Payer barriers (Pre-authorization) Capacity Adherence concerns Knowledge gap Information overload

19 How to Address Provider Feedback? Planning Questions What made HCV Prior Authorization so different than the management of other chronic conditions? How do we best support providers that accomplishes practice change without busting the budget? Which concerns have the greatest potential to make the biggest impact?

20 Specialty Pharmacies and Prior Authorizations Specialty Pharmacies Provide patient onboarding Dispense mediations using various methods that best meet patient Therapy-specific support Financial assistance Prior track record of public health and pharmacy partnerships in the past this made sense!

21 NACCHO Hepatitis C Public Health Detailing Kit Resources to help local health departments educate provider on testing, treating and linkage to care Provider Feedback Prior Authorization Medicaid Policies Adherence Concerns Diagnostic Questions Medication Questions Specialty Provider Concerns Detailing Kit Specialty Pharmacy Support HCA Policies TAG HCV Adherence CDC Testing Algorithm TAG HCV Adherence Project ECHO

22 Webpage Location: Hepatitis / Illness and Disease / Hepatitis / Hepatitis C Hepatitis C Overview: Detailing Kit Web Overview Dear Colleague Letter * Hepatitis C An Overview for Healthcare Providers (PowerPoint) * The Impact of Hepatitis C (quick guide) Hepatitis C General Information (CDC Quick Guide) Big HCV Overview (clients) Screening Guidelines and Diagnostics Hepatitis C Why Baby Boomer Should Get Tested (CDC) Hepatitis C & Injection Drug Use (CDC) Recommended Testing Sequence for Identifying Current Hepatitis C Virus Infection (CDC) Interpretation of Results of Tests for Hepatitis C Infection (CDC) Hepatitis C Clinical Support Tools (NYC Health) Hepatitis C Information on Testing & Diagnosis (CDC) Medication / Adherence / Specialty Support Hepatitis C Adherence (Treatment Action Group) Specialty Pharmacy Support Services (DOH) * Quick Check Hepatitis C Therapy Documentation (CVS) * Hepatitis C Enrollment Form (CVS) * Pharmaceutical Company Patient Assistance and Cost-sharing Assistance Programs (NASTAD) Telemedicine Case Consultation Project ECHO (DOH) *

23 Mail Advertise the Detailing Kit Top reporters for HCV Dear Colleague Letter Specialty Pharmacy Website Information Card HSQA Website Mirror NACCHOs format Epi Road Show 2018

24 Detailing Kit Strategy Aligns With.. PS1702 Improving HBV & HCV Care Cascade Strengthen screening and diagnosis within CHC/FQHC setting for at-risk populations PS1703 Strengthening Surveillance in Jurisdictions with High Incidence of HCV & HBV infections Optional Activity scale HCV & HBV screening within local county jails Washington State s Hepatitis C Strategic Plan Strategies to build a comprehensive, coordinated, sustainable statewide health care system and public health response

25 Next Steps Evaluation of utilization Identify mechanism for updating content Develop Detailing Kit for Local Health Jurisdictions LHJ role in reporting Foundational Public Health funds Template for other disease profiles

26 Questions? Nicole Dronen Infectious Disease Business Development Specialist WA State Department of Health Jonathan Stockton, MHA Adult Viral Hepatitis Prevention Coordinator WA State Department of Health

27 Hospital & Health Center Visits to Support Hepatitis C Screening and Reflex Testing in New York City JESSIE SCHWARTZ, RN, MPH CLINICAL COORDINATOR - VIRAL HEPATITIS PROGRAM NEW YORK CITY HEALTH DEPARTMENT

28 Outline Hepatitis C public health detailing in New York City: Context Hospitals, Federally Qualified Health Centers, 2015 Lessons learned

29 Context In New York City (NYC) prevalence of hepatitis C (HCV) infection is estimated at 2.4% in persons 20 years or older Diverse city; over 8.6 million residents 37% foreign born 20% live below the poverty level 26% have public health insurance coverage Approximately 40 acute care hospitals and 34 Federally-Qualified Health Centers (FQHCs)/Look-alikes

30 Context Limited resources for Viral Hepatitis Program (VHP) to have a city-wide public health detailing campaign External events precipitated additional outreach January 1, 2014: NYS Hepatitis C Testing Law New Direct Acting Antivirals (DAAS) in late 2013 Acute care hospitals selected as primary target In at least 1 staff member from the program visited ~32 acute care hospitals and 6 FQHCs

31 Hospitals Visits organized by VHP staff & administrative staff from hospitals Planning took 1-2 months VHP Medical Director and/or other staff attended meetings Requested Hospital Staff Attendance: Internal Medicine, HIV/Infectious Disease, Gastroenterology, psychiatry, drug treatment, laboratory directors, IT directors and leadership were all encouraged to attend Asked hospital team to complete a baseline survey when scheduling visit Focus on baby boomer cohort screening and reflex testing

32 Hospitals: Meeting Planning Borough Facility Name Date of Meeting Status Network Champion RNA testing Scheduled Attendees Address Admin contact **Site visit notes can be accessed by hovering mouse over 'Notes' cells with red tabs. To add/edit notes, select corresponding cell and click on Review Tab --> Add/Edit Comment **Purple highlight: HCV Champions **blue higlight: interested providers at each facility **green highlight: survey completed BOLDED: attendees present Bronx Bronx-Lebanon 5/22/2014 Meeting Dr. Matt Perry, Dr. AB done in Dr. ZZZZZ - Chair, Department of Internal Medicine ZZZZZZ@bronxleb.org Hospital Complet e Jennif er Anist on, house and Dr. ZZZZZ- Chief, Gastroenterology ZZZZZZ@bronxleb.org d Dr. Courtney Cox RNA at Quest. Dr. ZZZZZ - Med Director for Outpatient Dept ZZZZZZ@bronxleb.org Dr. ZZZZZZZ - Chief, Infectious Diseases ZZZZZZ@bronxleb.org Bronx Jacobi M edical 5/22/2014 Meeting Dr. Sean Austin, Dr. Dr. YYYYYYYY YYYYYY@NBHN.NET Center/ NCBH complete Winona Ryder, Dr. Dr. YYYYYYYY YYYYYY@NBHN.NET d. David Harbour Dr. YYYYYYYY YYYYYY@NBHN.NET Dr. YYYYYYYY YYYYYY@NBHN.NET Dr. YYYYYYYY YYYYYY@NBHN.NET Dr. YYYYYYYY YYYYYY@NBHN.NET Bronx Montefiore Medical 5/29/2014 Meeting Dr. Harrington, Dr. AB and RNA Dr. XXXXXXX XXXXX@montefiore.o Center complete Clar ke, Dr. in house but Dr. XXXXXXX XXXXX@montefiore.o d. Dinklage not reflexed Dr. XXXXXXXX - hepatologist XXXXX@montefiore.o apparently Dr. XXXXXXXX - HCV care in PC setting XXXXX@montefiore.o bec of Dr. XXXXXX - HCV/ HIV provider XXXXX@montefiore.o insurance Dr. XXXXXXXX - Infectious Disease XXXXX@montefiore.o barrier. Dr. XXXXXXX - Project Dragon Med Dir XXXXX@montefiore.o Dr. XXXXXXX XXXXX@montefiore.o Bronx St. Barnabas Hospital 6/23/2014 Meeting Dr. John Travolta Dr.WWWWW - Chair, Department of Internal wwww@sbhny.org complete (GI), Dr. Olivia Dr. WWWWWW - Chief, Infectious Diseases wwwwww@sbhny.or d. Newton-John (ID) Dr. WWWWW- Chief, Gastroenterology wwwww@sbhny.org John Doe is Dr. ZZZZZ's assist ant (JohnDoe@bronxleb.org), John Doe is Dr. ZZZZZZ's assist ant (JohnDoe@nbhn.net) John Doe is Sr. Secr et ar y, AIDS Cent er Administ r at ion (JohnDoe@montefiore.org), John Doe is Administ r at ive dir ect or in Dept of Internal Medicine (JohnDoe@sbhny.org),

33 Hospitals: General meeting structure Introductions Structured Presentation Discussion Goal Setting

34 Hospitals: What worked 1. Identifying an administrative point person to help coordinate 2. Having diverse departments within the hospital/facility represented 3. Grounding discussion in NYC-specific data 4. Having baseline information about the facility s current practices 5. Learning from hospitals/practitioners 6. Clear vision & objectives 7. Hepatitis C provider champions

35 Hospitals: Challenges 1. Short time for meetings precluded more in-depth discussions 2. No dedicated team for hepatitis C 3. Difficult to sustain engagement 4. Competing priorities 5. Medication prior authorization denials 6. Unable to quantify fiscal impact of reflex testing for internal laboratories

36 Federally-Qualified Health Centers, 2015 Visits organized by VHP staff and Program Mangers/Physicians (fewer administrative support staff available) Planning (still) took 1-2 months Invited: quality improvement, program managers, medical providers (generally ID/HIV/primary care), IT, and nursing Reviewed surveillance data from sites prior to meeting Focus on baby boomer birth cohort screening and reflex testing

37 Example: Surveillance data summary for FQHCs

38 Research sites & communities prior to visit. Information on Community Health Needs Assessments available at:

39 FQHCs: What worked 1. Ability to roll up your sleeves in smaller settings 2. Less hierarchy, change can happen rapidly 3. Building on existing innovations 4. Offering local resources and opportunities 5. Having patient materials available 6. Site-specific data

40 FQHCs: Challenges 1. Technical difficulties often presented without access to computer 2. Provider burnout/turnover was an issue 3. Competing priorities, such as meaningful use 4. Fewer support staff 5. Internal IT capability varied by site 6. Medicaid medication prior authorization denials

41 Overall Lessons Learned 1. Administrative, program, nursing and support staff are a crucial part of the quality improvement team 2. Plan to make the most of your visit 3. Be flexible 4. Keep presentations brief and specific 5. Local data is the best data 6. Follow up the next business day 7. Have clear objectives 8. Respond to requests & make yourself available

42 Contact: Hepfree.nyc

43 Questions? 43

44 Contact Us NASTAD s Hepatitis Testing Partnership Alyssa Kitlas Manager, Hepatitis akitlas@nastad.org NASTAD 444 North Capitol Street NW, Suite 339 Washington, DC Phone: (202)