Quality improvement to evaluate and provide treatment for chronic hepatitis C postpartum.

BACKGROUND: Chronic hepatitis C virus (HCV) infections are increasing among reproductive age individuals. Direct acting antivirals (DAAs) can cure HCV, but the use of DAAs is not currently recommended during pregnancy and breastfeeding. Individuals with HCV commonly have inadequate prenatal and postnatal care. OBJECTIVES: The purpose of our study was to demonstrate the success of a quality improvement program to increase evaluation during pregnancy and ensuring access to DAA treatment medication during the postpartum period for individuals with chronic HCV to achieve cure 12 weeks after completing therapy. The primary outcome was documented HCV cure rate compared among individuals who received immediate treatment with DAA after delivery or after weaning or a traditional approach of referral to an infectious diseases specialist or hepatologist. The secondary outcome was the proportion of infants exposed to HCV evaluated. METHODS: An interdisciplinary team developed a program to increase evaluation and HCV treatment for postpartum individuals. Individuals who received prenatal care from March 2017 to May 2021 were eligible. Individuals with chronic HCV had a laboratory evaluation before delivery, and appropriate DAAs were selected for postpartum treatment. The health system specialty pharmacy dispensed DAA prescriptions immediately after delivery to those who were not breastfeeding. Individuals who did breastfeed had the option to begin treatment after weaning. Cure was defined as a sustained viral response or undetectable HCV RNA collected 12 weeks after completing DAA treatment. RESULTS: We demonstrate the success of an interdisciplinary team to ensure access to therapy for the treatment of postpartum chronic HCV. Only 3 infants (25%) with mothers referred were evaluated at our institution compared with 44% of infants (n = 10) whose mothers were treated after delivery. CONCLUSION: An interdisciplinary team for HCV treatment improves access to treatment therapy with DAAs leading to the cure of chronic HCV after delivery.

Assistance with injectable medications: Implementation of a pharmacist-run specialty pharmacy injection clinic.

OBJECTIVE: The goal of this pilot study was to measure patient satisfaction, pain scores associated with injection, and patient perceptions of a pharmacist-led specialty injection clinic. SETTING: The Medical University of South Carolina Specialty Pharmacy. PRACTICE DESCRIPTION: The specialty pharmacy comprises decentralized clinical pharmacy specialists who provide medication education to patients via phone. Many of the medications dispensed are self-administered injectables, but patients often request in-person assistance to learn the best way to use the drug. The investigators sought to provide an avenue for patients to receive teaching and drug administration from a pharmacist without scheduling a formal nurse visit or enrolling the patients in a manufacturer program. PRACTICE INNOVATION: Clinical pharmacy specialists offered every patient a referral to the Assistance with Injectable Medication clinic for in-person injection teaching during the initial clinical assessment. At the first clinic visit, the patients were provided with printed injection instructions, and a demo injector from the manufacturer was available for practice before the actual drug administration. EVALUATION: This was a prospective pilot study conducted from January 2019 to April 2019. Patient identification occurred directly through our clinical pharmacy specialists via referrals and informational flyers. The eligible patients were aged 18 years or older and had received a qualifying subcutaneous injection via the Medical University of South Carolina Specialty Pharmacy. The outcomes included pain score and patient satisfaction. RESULTS: As of April 30, 2019, 17 patients had completed 24 clinic visits. The average reported pain and satisfaction scores (scale 0-10) were 2.5 and 9.6, respectively. The 2 most commonly administered medications in the clinic were alirocumab and adalimumab. CONCLUSION: A clinic to assist with specialty injectable medications resulted in high patient satisfaction scores and low pain scores associated with injection.