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Home > A study of the clinical impact and outcomes of pharmacist-led interventions in the outpatient model of care for Hepatitis C patients in Ireland and their development into a novel complex intervention toolkit.

Coghlan, Miriam (2020) A study of the clinical impact and outcomes of pharmacist-led interventions in the outpatient model of care for Hepatitis C patients in Ireland and their development into a novel complex intervention toolkit. PhD thesis, Trinity College Dublin.

URL: http://www.tara.tcd.ie/handle/2262/93214


Given the high rates of sustained virological response and good tolerability of direct-acting antiviral regimens, international guidelines now recommend that all Hepatitis C infected patients be considered for access to therapy. Hepatitis C infection presents specific challenges that requires having diversity in the available models of Hepatitis C patient care, regardless of who prescribes the DAA therapy. Non-specialist healthcare professionals treating patients with Hepatitis C infection, as part of a broader community-based model of care, require the right tools to enable them to successfully engage in treating patients.

 

The aim of this research project was to develop, evaluate and implement a complex intervention toolkit, based on pharmacist-led interventions in Hepatitis C patients care, to ensure optimum pharmacotherapy decision making at the initial prescribing step, and to increase training and prescribing rates among community treatment providers, who can reach the hard to treat populations whom are key if Hepatitis C elimination targets are to be achieved. Analysis of pharmacist-led interventions in Hepatitis C patient care, completed as part of this research identified a significant number of medication reconciliation variances and clinically significant drug-drug interactions which put patients at potential risk of Hepatitis C treatment failure, inappropriate co-morbidity management and patient morbidity.

 

These study findings provided justification for both medication reconciliation and drug-drug interaction analysis to form the basis of the novel complex intervention toolkit. A key guiding resource identified in complex intervention toolkit development was the UK Medical Research Council framework, for the development and evaluation of complex interventions. The toolkit moved from initial design, based on the outcomes of primary research conducted, and progressed through stakeholder review, feasibility testing, a pilot study and then on to an evaluation study.

The findings of the evaluation study confirmed the effectiveness of the PTPA toolkit in aiding pharmacists and doctors in selecting the optimum HCV treatment for patients (p <0.05) and in improving DDI detections rates among pharmacist, doctors and nurses (P< 0.05). The pre-treatment patient assessment (PTPA) complex intervention toolkit is a novel intervention incorporating all aspects of the PTPA process, to ensure optimum pharmacotherapy for all Hepatitis C patients in Ireland, across the continually expanding model of care, which strives to achieve Hepatitis C eradication. The potential for healthcare professionals working in all practice environments, including community, to safely assess and manage Hepatitis C treatment outside of specialist centres, can be supported using this toolkit. This type of capacity building within our limited healthcare resources is key to up-scaling the model of care in Ireland and internationally to achieve World Health Organisation elimination targets.

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