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Purpose: The Department of Veterans Affairs (VA) is the largest single provider of HCV care in the US. In May 2011, new direct acting antiviral agents (DAA) were approved by the FDA. We anticipate increased numbers of veterans will seek care; thus, additional trained providers are needed to meet demand. Pharmacists with advanced training are in an ideal position to provide care for HCV patients receiving DAAs due to the complicated regimens, long duration of therapy, drug-drug interactions, and the need for close monitoring of adherence, adverse effects and laboratory values. The purpose of the presentation is to: 1) describe the process of integrating a clinical pharmacy specialist into an existing HCV practice, and 2) describe clinical pharmacist activities of viral hepatitis management.
Methods: All patients seen and evaluated by both physician and pharmacist for treatment from July 2011 through June 2012 were included. A scope of practice was developed and approved by the medical staff. The pharmacist was imbedded in the Hepatology clinic and had alternating office visits with a physician provider. Patient encounters were tracked using an electronic medical record system.
Results: A total of 45 patients were evaluated for treatment by the physician-pharmacist team and 34 received treatment with a DAA regimen during the 12 month period. The majority of patients initiating treatment were male (94%), African-American (55%), and the median age was 59 years. A total of 144 encounters were documented representing an average of 4.2 visits per patient. Clinical activities included patient education, drug-interaction management, adherence assessment, side effect management, and medication dosage adjustment.
Conclusion: A pharmacist trained in HCV management was successfully integrated into a HCV clinic within the VA and provided a variety of important clinical activities. Further analysis is required to correlate improved access to treatment outcomes.