The advent of directly acting anti-viral agents (DAAs) for HCV infection has transformed the therapeutic landscape. DAAs have an excellent safety record, and can be stratified for use in community environments which better meet patient needs. We present a pilot study of a novel home based care pathway, delivered by a partnership between the local Operational Delivery Network (ODN), specialist hepatitis services and clinical Pharmacy.Methods
HCV infected patients assessed at the ODN multidisciplinary team meeting (MDT) as eligible for DAAs were screened for entry to the study by the following criteria: competence to adhere to therapy without direct supervision; no current or previous evidence of hepatic decompensation; contactable by telephone. Following recruitment, patients received a pack containing: blood forms; a schedule for community blood testing; information leaflets; details of hospital contacts. DAAs were delivered to the patient home each month by Pharmacy. A dedicated Pharmacy technician acted as initial contact for patient queries, with support from the lead nurse specialist. The homecare technician worked closely with the nursing team, the MDT co-ordinator and ODN Manager to co-ordinate the service. Lab Results were reviewed by the lead nurse. Patients were invited to report outcome measures and feedback using structured questionnaires.Results
Of 121 patients offered a choice of home or hospital based care by January 2018, 97 (80%) elected to receive treatment at home. This group did not differ significantly in age, gender, HCV genotype or choice of DAA from those treated in the hospital clinic. 14 homecare patients met Fibroscan criteria for cirrhosis. Of the 97 patients so far started on treatment, 57 have completed, 31 achieved SVR and 4 have failed treatment. Three patients withdrew from the study for reasons unrelated to homecare and one transferred back to hospital care. 18 feedback questionnaires have been received from 56 so far sent (32%). All respondents stated that the service had lived up to or exceeded expectations, and was particularly valued by patients living distant from the hospital.Conclusions
Homecare provides a safe, transferable and scaleable treatment option which is preferred by patients. The strategy of pharmacy based implementation and economies of staff time intrinsic to the homecare model will relieve pressure on hepatitis services, and allow specialist teams to focus on patients with severe co-morbidities and promoting models for case finding and community care for harder to reach groups with HCV infection.