Theme: Models of Care Year: 2024
Background: Before 2019 patients with hepatitis C (HCV) in North Wales (N.Wales) were treated via hospital outpatient clinics. As elsewhere, HCV in N.Wales is most prevalent amongst people who inject drugs and this group often miss hospital appointments and get discharged from waiting lists.
Description of model of care/intervention/program: An accelerated community HCV pathway was agreed. In 2019 a pilot project began at Wrexham’s Salvation Army church which held weekly drop-in sessions for those experiencing homelessness. A blood-borne virus (BBV) team (pharmacists, BBV/Harm Reduction nurses) attended weekly offering rapid point-of-care HCV testing. Those testing positive had medication prescribed by independent-prescribing pharmacists and brought to drop-in sessions.
Medication could be dispensed weekly for patients without safe storage. Support was given as needed. In some cases through encouragement, in others more practically, e.g. basic mobile phones enabling patients to keep in touch. There was a flexible approach with no fixed appointments.
COVID-19 forced changes but clinics continued with nurses seeing patients in Substance Misuse buildings, and pharmacists joining online. Appointment times were then given but patients receive reminders/ support, and missed appointments do not mean forgoing treatment. This approach also proved successful and funding was obtained to roll-out accelerated community pathway across N.Wales.
Effectiveness: Over 150 patients have been treated across N.Wales through pharmacist-led community clinics. Many individuals had HCV for years (in one case 20) but felt unable to access treatment previously.
Patients also reported other impacts of HCV treatment including a man feeling able to see his children again after years of feeling “dirty” and fearing passing HCV to them, and patients feeling more confident to get other health issues investigated following positive engagement with healthcare.
Conclusion and next steps: This programme has reached many vulnerable patients unable to access treatment previously and proves that a simplified community approach works.
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