Comparative effectiveness of pharmacist care delivery models for hepatitis C clinics
The optimal health care delivery models for providing services to patients with infections caused by hepatitis C virus (HCV) remain unknown. Pharmacist involvement may be a key component of optimal HCV care delivery. We examined the comparative effectiveness of a pharmacist-managed HCV clinic versus a pharmacist-assisted HCV clinic.
This retrospective cohort study used electronic health record data on patients ≥18 years old initiating HCV treatment at a pharmacist-managed clinic or a pharmacist-assisted clinic within a single health-system between January 2015 through June 2017. Outcomes included treatment completion, sustained virologic response 12 weeks following treatment completion (SVR-12), and dispensation of direct-acting antiviral agents at the institution-based specialty pharmacy. Inverse probability of treatment-weighted (IPTW) logistic regression models were used to compare outcomes between the 2 clinic models.
A total of 127 patients initiated HCV treatment therapy: 64 patients from the pharmacist-managed clinic and 63 patients from the pharmacist-assisted clinic. The cohort had a mean age of 55 years, was 51% male, and 68% white. In IPTW analyses, there was no difference in treatment completion (odds ratio [OR], 1.1; 95% confidence interval [CI], 0.1-13.8; p = 0.93), achievement of sustained virologic response at 12 months (SVR-12) (OR, 1.0; 95% CI, 0.2-4.5; p = 0.62), or use of institution-based specialty pharmacy (OR, 0.6; 95% CI, 0.2-1.7; p = 0.33) between pharmacist-managed and pharmacist-assisted clinics.
There were no significant differences in outcomes between patients receiving care at the pharmacist-managed HCV clinic and the pharmacist-assisted clinic. Given the frequency of SVR-12 achieved in both groups, both pharmacist-managed and pharmacist-assisted clinic models may be reasonable alternatives for providing outpatient HCV care.
Am J Health Syst Pharm. 2019 Mar 15. pii: zxz034. doi: 10.1093/ajhp/zxz034. [Epub ahead of print]
Department of Pharmacy, Rhode Island Hospital, Providence, RI.
Department of Pharmacy, Rhode Island Hospital, Providence, RI, and Department of Health Services, Policy, and Practice, Brown University, Providence, RI.
Department of Epidemiology, Brown University School of Public Health, Providence, RI.
Lifespan Corporation-Rhode Island Hospital, The Miriam Hospital, Bradley Hospital, Providence, RI, and Lifespan Pharmacy, LLC, Providence, RI.