6533b7d9fe1ef96bd126b9a8
RESEARCH PRODUCT
Optimizing patient referral and center capacity in the management of chronic hepatitis C: Lessons from the Italian experience
Massimo ColomboGiovanni Battista GaetaGiovanni Di PerriGioacchino AngaranoAlessandra MangiaGiuseppe IppolitoAlfredo AlbertiVito Di MarcoAntonio CraxìPatrizio Pasqualettisubject
AdultMalemedicine.medical_specialtyDelphi TechniqueGeneral PracticeDelphi methodDelphi methodAntiviral AgentsDrug PrescriptionsHealth Services AccessibilityMedication AdherencemodelsPatient referralTreatment targetsChronic hepatitismedicineHumansdelphi method; direct-acting antivirals; disease eradication; hepatitis c virus; adult; aged; antiviral agents; disease eradication; drug prescriptions; female; general practice; health care surveys; health services accessibility; hepatitis c chronic; humans; italy; male; medication adherence; middle aged; models theoretical; quality Improvement; referral and consultation; delphi techniquehepatitis cMedical prescriptiontheoreticalReferral and Consultationdirect-acting antiviralsAgedHepatitisdirect-acting antiviralHepatologyDisease Eradicationbusiness.industryHepatitis C virusGastroenterologyDrug agencyHepatitis C ChronicMiddle AgedModels Theoreticalmedicine.diseaseQuality ImprovementchronicItalyHealth Care SurveysFamily medicineFemaledisease eradicationbusinessdescription
Abstract Aims In 2017 the Italian Drug Agency (Agenzia Italiana del Farmaco, AIFA) revised the criteria for access to therapy for patients with chronic hepatitis C as part of a three-year plan to eradicate HCV. We conducted a Delphi study to determine strategies to identify and treat patients with HCV and to develop through a shared pathway, a model to manage patient referral and optimize prescription center capacity with the overall aim of increasing access to therapy. Methods The process took place in two phases – Phase I (January 2017), before the criteria for treatment of HCV were revised and Phase II (May 2017) when AIFA developed a framework for the eradication of HCV infection in Italy. Two questionnaires were devised with Q1 administered in Phase I and Q2 in Phase II. Results Q1 was sent to 823 hepatitis specialists working in 235 Italian HCV centers authorized to prescribe direct-acting antiviral drugs (DAAs). Overall, 167 centers (71%) participated with a good geographical representativeness (North 69%, Centre 74%; South and islands 70%). 548 prescribers (68.8%) provided responses to Q1 and 443 (80%) specialists who responded to Q1 completed Q2. Over 70% considered that to meet the new therapy targets local/regional networks need to be consolidated and reinforced with GPs providing the ‘missing link’ in current regional networks. Adherence to therapy was considered important by 75% of clinicians with reduction in follow-up intervals/length considered important by 65% – to free up staff/resources to manage increasing numbers of new patients. About 80% of respondents stated that medical personnel were principally involved in follow-up with follow-up having a significant impact on center capacity. Conclusion Enhancing patient referral, the need for an increased role of GPs, increasing center capacity in particular medical personnel in outpatient centers and greater liaison between Hub centers and healthcare professionals currently managing high-risk groups as yet untreated, were factors that need to be streamlined in order to meet treatment targets for eradication of HCV.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-01-01 |