Therapeutic Advances in HCV Genotype 1 Infection: Insights from the Society of Infectious Diseases Pharmacists.

Hepatitis C virus (HCV) is the most common blood-borne infection in the United States. The high morbidity and mortality due to untreated infection have prompted updated screening recommendations that now include one-time HCV screening for all patients born between 1945 and 1965, in addition to risk factor-based screening. Current guidelines recommend treatment for all patients with chronic HCV. Treatment for HCV genotype 1 has evolved dramatically since the approval of the direct-acting antivirals. The approval of ledipasvir-sofosbuvir, ombitasvir-paritaprevir-ritonavir and dasabuvir, and simeprevir with sofosbuvir has dramatically altered the treatment landscape. High sustained virologic response (SVR) rates favor treatment, yet access to care poses a challenge for patients and providers. Current and emerging data with new therapies indicate high SVR rates in treatment-naïve and treatment-experienced patients, including patients with cirrhosis and in other special populations. Additional data suggest the addition of ribavirin can decrease treatment duration without compromising SVR rates. Resistance is an increasing area of interest in HCV, with baseline mutations identified and the potential for the development of resistance-associate variants in patients undergoing treatment. Due to the rapid evolution of HCV treatment, pharmacists should address challenges and play an integral role in agent selection, dosing, drug interaction screening, adverse effect monitoring, and the coordination of treatment. Clinical application of the latest information will reduce patient risk and improve outcomes.

Medication reconciliation in a community, nonteaching hospital.

PURPOSE: A medication reconciliation program involving physicians, pharmacists, nursing staff, and other personnel at a community hospital is examined. SUMMARY: The Joint Commission required hospitals to have a procedure in place for reconciling patient medication across the continuum of care by January 1, 2006. A multidisciplinary team was formed to address reconciliation of medications at DuBois Regional Medical Center. Baseline data on the number of medications unreconciled at admission, transfer, and discharge were collected. A reconciliation process and policy were developed and implemented. The pilot program took place on a nursing unit with a select group of physicians who were known leaders, who had a substantial patient volume, and who showed an interest in the program. Letters were sent to physicians to outline the opportunities of the program. The letters encouraged physicians to participate and cited advantages such as decreased legibility issues, less opportunity for transcription error, improvement in accuracy, convenience, and time saved by using electronically generated lists instead of lists written by hand. Continuous audits, feedback, and education provided an ongoing assessment of the benefit of the program in terms of reduction of unreconciled medications and highlighted opportunities for improvement. In June 2005, baseline statistics of unreconciled medications at admission and discharge were 15% and 18%, respectively. Following implementation of the program, numbers fluctuated but improved. During the second half of 2007, the percentages of unreconciled medications on admission and at discharge were less than 10% and continued the trend downward to less than 5%. CONCLUSION: A community hospital has instituted a medication reconciliation program that involves physicians, pharmacists, nursing staff, and other personnel. Audits, feedback, and education are key components in the program's operation and improvement.