Assessment of an education tool to improve knowledge and reduce stigma of a syringe service program (SSP) at a VA Medical Center.

BACKGROUND: Drug overdose deaths are a growing epidemic in the United States owing in part to inadequate support from health care systems. In response, the Veterans Health Administration (VHA) plans to implement syringe service programs (SSPs) across VHA medical centers. This SSP education project aims to positively affect health care staff perceptions regarding SSPs and reduce the stigma surrounding substance use. OBJECTIVES: The purpose of this research was to allow Advanced Pharmacy Practice Experience (APPE) students to implement and assess an educational program regarding SSP enactment at this institution. Furthermore, the objectives of the educational program were to address the stigma associated with substance use and provide knowledge to staff about SSPs. PRACTICE DESCRIPTION: Eleven complete and one abbreviated (no questionnaire) presentations were delivered by APPE students throughout the main facility and outpatient clinics, with presentations being delivered to physicians, nurses, and a range of other professions. PRACTICE INNOVATION: APPE students developed educational content and pre- and postsurveys that were used to assess for changes in knowledge and perception surrounding substance use and SSPs. EVALUATION METHODS: The primary outcome was to assess individual pre- and postprogram survey responses using mean, SD, and mean change to measure the impact that the presentation had on individualized stigma. RESULTS: A total of 104 completed surveys were analyzed in Microsoft Excel and subcategorized by profession; 10 of the 15 questions asked in the questionnaire yielded statistical significance when comparing pre- and postpresentation results (P < 0.05). CONCLUSIONS: A presentation method developed and delivered by APPE students resulted in a statistically significant change in perception and knowledge, proving to be an effective method for educating health care staff on SSPs.

Assessment of hepatitis C monitoring adherence after viral eradication in veterans with substance use to improve care and surveil reinfection.

Introduction: Hepatitis C virus (HCV) incidence rates are rising for patients with substance use and/or SUDs. Guidelines provide monitoring recommendations to ensure remission after successful treatment. The study's objective was to identify gaps in follow-up for patients with documented substance use and/or SUD through assessment of adherence to guideline-recommended HCV RNA lab 12 months post-treatment. Methods: Patients treated for HCV through the Veteran Health Indiana Hepatitis C Pharmacy Clinic were retrospectively evaluated. Subjects were categorized based on the provider assigned for follow-up care after 12-week sustained virologic response (SVR12) labs (primary care provider [PCP] or HCV provider). The primary outcome was HCV RNA obtained 11 to 13 months post-treatment. Secondary outcomes were HCV RNA detected post-treatment, substance use, engagement in substance use treatment, and engagement with social work. Results: Two hundred forty-one patients were included in the HCV provider cohort and 139 in the PCP cohort. Forty-one patients did not have a specified clinic for follow-up treatment, and 20 patients did not achieve SVR12. Sixty-one patients (28%) in the HCV provider cohort completed a 12-month HCV RNA within 11 to 13 months post-treatment vs 15 patients (11%) in the PCP cohort (P ≤ .01). One patient had HCV RNA detected post-treatment. Discussion: This study reveals inadequate HCV post-treatment follow-up for patients with substance use and/or SUD. SUD is a chronic disease that requires continued monitoring to prevent complications. Further studies are needed to identify reinfection rates and improvements of care in this population.

HCV eradication in veterans with underlying mental health disorders and substance use.

OBJECTIVE: Hepatitis C virus (HCV) disproportionately affects those with mental health disorders and those with substance use, and the increasing HCV transmission in the United States is driven by the opioid epidemic. However, patients with a mental health disorder, substance use, or combination of both historically have had limited access to HCV treatment. The goal of our study was to compare sustained virologic response (SVR) rates of HCV treatment with direct-acting antivirals (DAAs) between subjects with and without a mental health disorder, substance use, or combination of both. METHODS: We performed a retrospective chart review at 1 Veterans affairs medical center of patients enrolled in the hepatitis C pharmacy clinic who completed DAA treatment from August 17, 2013 to August 17, 2017. The participants (N = 833 patients) were categorized into 2 groups: those with at least 1 mental health disorder, substance use, or combination of both and those without. Baseline variables relevant to HCV treatment, DAA regimen, number of documented efforts to engage patients, and SVR data were collected. RESULTS: Of the 833 study participants, 579 patients had a mental health disorder, substance use, or combination of both. The 3 most prevalent disorders were patient-reported substance use (n = 333), substance-related and addictive disorders (n = 176), and depressive disorders (n = 159). The SVR rates and number of documented efforts to engage patients before and during treatment through SVR laboratory completion between those with a mental health disorder, substance use, or combination of both and those without were not statically significant. CONCLUSION: DAA-based HCV treatment is highly effective with SVR rates exceeding 95% in the entire study cohort, including patients with or without mental health disorders, substance use, or combination of both.

Pharmacist-driven multidisciplinary pretreatment workup process for hepatitis C care: A novel model for same-day pretreatment workup.

OBJECTIVES: The objective is to describe and quantify the impact of a novel practice model for pharmacist involvement in care coordination and patient education in hepatitis C virus (HCV) care. SETTING: This practice model was implemented in the gastroenterology clinic at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana. PRACTICE DESCRIPTION: Traditional pretreatment workup for HCV requires multiple on-site appointments to complete imaging and laboratory assessments and for provider and social work appointments. High pretreatment time burden and increasing psychosocial complexity of the patient population present significant barriers to HCV eradication. Patients frequently miss appointments, and each on-site visit creates a separate opportunity for patients to be lost to follow-up. PRACTICE INNOVATION: The pharmacist-driven multidisciplinary pretreatment workup process was launched by HCV pharmacists to mitigate barriers. Patients complete the pretreatment evaluation process, which includes same-day pharmacy education, provider visit, social work assessment, FibroScan, and laboratory assessments, in approximately 2.5 hours. EVALUATION: Forty-six patients who completed the pharmacist-driven multidisciplinary pretreatment workup process versus 235 patients who completed traditional workup were analyzed for time from date of HCV consultation placement to treatment start and time from most recent HCV provider visit to treatment start. RESULTS: From time of HCV consult entry to date of treatment start, patients were initiated on HCV treatment in an average of 42.2 ± 7.5 days and 184.1 ± 27.6 days (P = 0.0001) within the intervention and traditional workup groups, respectively. A decreased time from most recent HCV provider visit to treatment initiation was noted between groups with 38.2 ± 7.1 days and 54.7 ± 3.6 days (P = 0.04) in the intervention and traditional workup groups, respectively. CONCLUSION: The pharmacist-driven multidisciplinary pretreatment workup process is an effective way to engage patients and decrease time to treatment initiation. This model could be replicated in other practice settings, especially those challenged by multi-step care coordination.