April 28, 2014 6:02 am by Vickie Andros
These are exciting times in the treatment of hepatitis C virus infection. The outlook for patients with hepatitis C has greatly improved with available treatment options offering a cure for many.
Until 2011, the standard of care for patients with hepatitis C was combination treatment of pegylated interferon and ribavirin. Treatment with peginterferon and ribavirin has been associated with significant side effects, worsening fatigue and decline in health-related quality of life.(1) Nonadherence to peginterferon and ribavirin treatment for hepatitis C has been a major barrier to treatment success. (2)
The landscape of treatment for hepatitis C is rapidly changing with approval of oral agents that produce better cure rates, are better tolerated and provide shorter duration of treatment. Numerous new agents are also expected to become available in 2014 and 2015 that will offer more effective, simpler all oral, interferon-free treatment regimens. For these reasons, many patients will demand these newer treatments.
Studies examining adherence to hepatitis C combination treatment with peginterferon and ribavirin have shown an increased risk of virologic failure in poorly adherent patients. (3)
Due to the high cost of these new treatments, the possibility that the virus could become resistant if adherence is not optimal, and that good outcomes are dependent upon adherence (4), it is important to provide patient support to ensure adherence to treatment is maintained throughout the course of therapy.
Physicians may not be able to meet the current and future demands of increased access to care and there exists the lack of capacity of our system to provide comprehensive care to patients. Other health care providers are needed to support the physician and the patient.
Clinicians need to educate patients regarding disease progression, potential of long-term clinical consequences if treatment is postponed, and challenges of treatment-related side effects. Understanding factors associated with patient non-adherence is also important in identifying opportunities for education. Side effects, including fatigue, headache and depression, are the most common reason for discontinuing treatment.
Studies have shown that educational interventions with behavioral support through continued patient contact over several weeks or months were effective for several chronic diseases, including hypertension, hyperlipidemia, heart failure, and myocardial infarction. (5) Pharmacist delivered patient care services have also been shown to increase medication adherence in other chronic disease states. (6)
Pharmacists are in the ideal position to help with adherence in terms of explaining the purpose of medications, how to take them, and the importance of staying on them. They are in a sense the most accessible providers in the health care system, but often are underutilized as a resource for improving medication adherence.
Pharmacists who provide comprehensive medication therapy management (MTM) services for patients with hepatitis C have the opportunity to assess the patient’s functional status and understanding about his/her diseases and treatments. Through this process pharmacists may also identify which treatment factors matter most to the patient – especially the side effects that lead to patients missing doses or discontinuing treatment. In doing so, the pharmacist is able to provide patient specific education and a side effect management plan for the patient.
Routine pharmacist follow-up with the patient throughout the treatment period (12-24 weeks) to assess adherence, address any concerns from previous communications, and identify and resolve medication related issues that may lead to non-adherence is helpful in assisting the patient to adhere to therapy.
Individual counseling, support and patient education from a health care provider other than the physician can help increase treatment adherence that results in the cure of hepatitis C.
References
1. Fusfeld L, Aggarwal J, Dougher C, et al. Assessment of motivating factors associated with the initiation and completion of treatment for chronic hepatitis C virus (HCV) infection. BMC Infect Dis 2013;13:234.
2. Evon DM, Esserman DA, Bonner JE, et al. Adherence to PEG/ribavirin treatment for chronic hepatitis C: prevalence, patterns, and predictors of missed doses and nonpersistence. J Viral Hepatitis 2013;20(8):536-549.
3. Lieveld FI, van Vlerken LG, Siersema PD, van Erpecum KJ. Patient adherence to antiviral treatment for chronic hepatitis B and C: a systematic review. Ann Hepatology 2013;12(3):380-391.
4. Lo Re V III, Amorosa VK, Localio AR, et al. Adherence to hepatitis C virus therapy and early virologic outcomes. Clin Infect Dis 2009;48(2):186-193.
5. Viswanathan M, Golin CE, Jones CD, et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012;157(11):785-795.
6. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol. JAMA 2006;296:2563-257.1
Read more: http://medcitynews.com/2014/04/pharmacists-key-helping-patients-payers-get-roi-expensive-hepatitis-c-meds/#ixzz30BIAm1sx
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