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Integrating community pharmacy testing for hepatitis c with specialist care

Integrating community pharmacy testing for hepatitis c with specialist care
Integrating community pharmacy testing for hepatitis c with specialist care

Background: Many patients with hepatitis C virus (HCV) infection lie undiagnosed and a significant proportion of patients that have been identified are disengaged from specialist services. The Isle of Wight (IOW) typifies this issue, with an estimated 200 undiagnosed patients with HCV infection and a small number of known cases engaged with specialist services. Aim: To reduce the burden of undiagnosed HCV on the IOW and link new diagnoses directly to specialist care. Service development, design and implementation: Dry blood spot tests were undertaken at community pharmacies for HCV, hepatitis B, HIV and syphilis. Individuals testing positive for HCV RNA or hepatitis B surface antigen were automatically referred to the mainland hepatology service and were seen at a pharmacy 'point-of-diagnosis' consultation with the testing pharmacist and hepatologist. Pharmacy testing activity was compared with the local drug support centre (island recovery integrated service [IRIS]). Service outcomes: Over a period of nine months (September 2014 to May 2015), a total of 88 tests were performed at community pharmacies. Of these, 39 of the individuals tested reported injecting drug use as their main risk factor; 17 of these were not engaged at IRIS and were significantly less likely to have had a previous test (77% vs. 41%, P =0.04). During the same period at the IRIS centre, 34 tests were performed. A greater proportion of individuals had a history of injecting drug use (85%, P <0.01) and were more likely to have had a test in the past three years (56%P, =0.07). Overall, 7% of pharmacy tests and 9% of IRIS tests were positive for HCV RNA (P =0.7); all pharmacy cases were seen at a point-of-diagnosis consultation with a hepatologist Conclusion: Pharmacy-based testing has the potential to reach at-risk individuals who are not tested for HCV elsewhere. When combined with integrated specialist referral, it has the potential to reduce the burden of undiagnosed HCV and engage new diagnoses directly with specialist care.

Case finding, Diagnosis, Dry blood spot, Hepatitis c, Hepatology, Pharmacy
1758-9061
Buchanan, Ryan
f5977149-8e3c-42b9-9044-cfd36c0c10b5
Hassan-Hicks, Pembe
c0b4c482-6a71-4908-b515-44511f74bb1e
Noble, Kevin
6f77c0d6-c032-4c9d-9b95-17b80e752a94
Grellier, Leonie
5b353bf7-3bab-4510-8195-d5c9433b9f01
Parkes, Julie
58bd4170-0b6f-4a35-ae05-a6c8670e6bdb
Khakoo, Salim I.
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Buchanan, Ryan
f5977149-8e3c-42b9-9044-cfd36c0c10b5
Hassan-Hicks, Pembe
c0b4c482-6a71-4908-b515-44511f74bb1e
Noble, Kevin
6f77c0d6-c032-4c9d-9b95-17b80e752a94
Grellier, Leonie
5b353bf7-3bab-4510-8195-d5c9433b9f01
Parkes, Julie
58bd4170-0b6f-4a35-ae05-a6c8670e6bdb
Khakoo, Salim I.
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273

Buchanan, Ryan, Hassan-Hicks, Pembe, Noble, Kevin, Grellier, Leonie, Parkes, Julie and Khakoo, Salim I. (2016) Integrating community pharmacy testing for hepatitis c with specialist care. Clinical Pharmacist, 8 (8). (doi:10.1211/CP.2016.20201549).

Record type: Article

Abstract

Background: Many patients with hepatitis C virus (HCV) infection lie undiagnosed and a significant proportion of patients that have been identified are disengaged from specialist services. The Isle of Wight (IOW) typifies this issue, with an estimated 200 undiagnosed patients with HCV infection and a small number of known cases engaged with specialist services. Aim: To reduce the burden of undiagnosed HCV on the IOW and link new diagnoses directly to specialist care. Service development, design and implementation: Dry blood spot tests were undertaken at community pharmacies for HCV, hepatitis B, HIV and syphilis. Individuals testing positive for HCV RNA or hepatitis B surface antigen were automatically referred to the mainland hepatology service and were seen at a pharmacy 'point-of-diagnosis' consultation with the testing pharmacist and hepatologist. Pharmacy testing activity was compared with the local drug support centre (island recovery integrated service [IRIS]). Service outcomes: Over a period of nine months (September 2014 to May 2015), a total of 88 tests were performed at community pharmacies. Of these, 39 of the individuals tested reported injecting drug use as their main risk factor; 17 of these were not engaged at IRIS and were significantly less likely to have had a previous test (77% vs. 41%, P =0.04). During the same period at the IRIS centre, 34 tests were performed. A greater proportion of individuals had a history of injecting drug use (85%, P <0.01) and were more likely to have had a test in the past three years (56%P, =0.07). Overall, 7% of pharmacy tests and 9% of IRIS tests were positive for HCV RNA (P =0.7); all pharmacy cases were seen at a point-of-diagnosis consultation with a hepatologist Conclusion: Pharmacy-based testing has the potential to reach at-risk individuals who are not tested for HCV elsewhere. When combined with integrated specialist referral, it has the potential to reduce the burden of undiagnosed HCV and engage new diagnoses directly with specialist care.

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More information

Accepted/In Press date: 22 June 2016
e-pub ahead of print date: 5 August 2016
Keywords: Case finding, Diagnosis, Dry blood spot, Hepatitis c, Hepatology, Pharmacy

Identifiers

Local EPrints ID: 412330
URI: https://eprints.soton.ac.uk/id/eprint/412330
ISSN: 1758-9061
PURE UUID: 611fc681-6fcc-47fb-b19b-e6a40e7a28cc

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Date deposited: 17 Jul 2017 13:29
Last modified: 13 Mar 2019 19:48

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Contributors

Author: Ryan Buchanan
Author: Pembe Hassan-Hicks
Author: Kevin Noble
Author: Leonie Grellier
Author: Julie Parkes
Author: Salim I. Khakoo

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