A pharmacist-led program in Ohio is streamlining the path to hepatitis C treatment and drawing national attention from public health experts.
At AxessPointe Community Health Centers, one of a group of five federally qualified health centers in the Akron, Ohio, area, the median time from the initial visit to initiation of therapy was 37 days for patients in the pharmacist-led hepatitis C program, according to findings published in Public Health Reports.
By contrast, a study from an Indiana institution found that the median time to treatment initiation was 300 days, and data on Medicaid enrollees from 2019 to 2020 showed that 77% of patients with hepatitis C had not started treatment within a year of diagnosis.
At AxessPointe, primary care providers screen patients for hepatitis, but “once we get a referral for hepatitis C management, the pharmacist takes full control of every aspect,” said Kenneth Furdich, clinical pharmacy manager for the health centers and an assistant professor of pharmacy practice at Northeast Ohio Medical University.
Under a collaborative practice agreement, the pharmacy team orders necessary laboratory tests, looks for barriers to medication adherence, counsels patients, manages prior authorizations, and monitors patients for adverse events and disease progression. Once treatment is complete (at least 12 weeks), pharmacists order final labs.
Among the 212 patients in the Ohio study who completed follow-up laboratory testing, hepatitis C was undetectable in 194.
These results are notable given the complexity of the health centers’ patient population: 79% are insured through Medicaid, and nearly 82% have a substance use disorder.
The report’s authors say faster treatment initiation may also increase treatment completion in these challenging populations.
“It can be fairly significant if you start taking the medicine and then stop it, because you could develop some form of resistance,” Furdich said. “It’s important that we ... follow them really closely.”
Most of the participating health centers have onsite dispensing pharmacies and offer delivery services to overcome barriers that could cause delays or lead to patients not picking up their medications, he said.
Health departments in the counties where the program operates took note of the cure rates and reached out to find out what was happening, said Magdi Awad, director of pharmacy for AxessPointe and a professor of pharmacy practice at Northeast Ohio Medical University.
Now, health department representatives hand out the program’s business cards and brochures during needle exchanges and other community events, which has brought more patients into treatment. In one case, a nursing home case manager called Awad about a referral for a patient who had been untreated for HCV for over five years. The patient came to their appointment asking when they could see the pharmacist to get treatment.
Awad, a member of ASHP’s Section of Community Pharmacy Practitioners, said the clinic’s work builds upon 15 years of pharmacist management of diabetes, hypertension, asthma, and chronic obstructive pulmonary disease. “We were able to build an entire program, with seven in-house pharmacies, a specialty pharmacy, and five residents every year,” he said.
When the pharmacy team added hepatitis C management to its repertoire, “we noticed that our patients might take four to six months before they could see a specialist,” Awad said. “Most specialists realize that hepatitis C is something that can be managed in primary care, so the [infectious diseases] or hepatology specialists are limiting their available appointments for something like this.”
Awad and colleagues submitted their findings to a public health journal to promote broader awareness of pharmacists’ capabilities.
“It was very interesting to work with the reviewers, who did not see pharmacists do clinical work and never saw pharmacists publish things like this,” Awad said. “They were asking us all of these questions unrelated to the study: ‘When did pharmacists start to prescribe? Can pharmacists manage other disease states?’ We had to educate them and provide them with resources about what clinical pharmacy is and what we are able to do. I’m glad that we reached out to a new group of readers through that journal.”
Furdich said the work has additional special meaning for him. He did his residency at AxessPointe with Awad as his program director and preceptor.
“I got a lot of the training that I use in my career here,” Furdich said. “Being able to make this service was a way that I was able to do good for the community.”
