Barriers and facilitators to implementing a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) to treat hepatitis C among people who inject drugs.

Autor: Austin EJ; Department of Health Systems and Population Health, University of Washington, Seattle WA, United States. Electronic address: austie@uw.edu., Gojic AJ; Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States., Bhatraju EP; Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States., Pierce KA; Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States., Pickering EI; Department of Social and Behavioral Sciences, Yale School of Public Health, United States., Tung EL; Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States., Scott JD; Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States., Hansen RN; Department of Pharmacy, University of Washington, Seattle WA, United States; Kelley-Ross Pharmacy Group, Seattle WA, United States., Glick SN; Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States; HIV/STD Program, Public Health - Seattle & King County, Seattle WA, United States., Stekler JD; Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle WA, United States., Connolly NC; Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States., Villafuerte S; Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)., McPadden M; Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)., Deutsch S; Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)., Ninburg M; Hepatitis Education Project, Seattle WA, United States (affiliation at the time of research)., Kubiniec R; Evergreen Treatment Services, Seattle WA, United States., Williams EC; Department of Health Systems and Population Health, University of Washington, Seattle WA, United States; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle WA, United States., Tsui JI; Department of Medicine, Division of General Internal Medicine University of Washington, Seattle WA, United States.
Jazyk: angličtina
Zdroj: The International journal on drug policy [Int J Drug Policy] 2023 Jan; Vol. 111, pp. 103924. Date of Electronic Publication: 2022 Dec 13.
DOI: 10.1016/j.drugpo.2022.103924
Abstrakt: Background: Direct-acting antivirals (DAAs) offer an unprecedented opportunity to eliminate hepatitis C virus (HCV) infection, yet barriers among people who inject drugs (PWID) remain. Having pharmacists provide care through collaborative drug therapy agreements (CDTAs) offers a promising solution. We developed and piloted a Pharmacist, Physician, and Patient Navigator-Collaborative Care Model (PPP-CCM) which utilized pharmacists to directly deliver HCV care at community organizations serving PWID. We conducted formative evaluation of the PPP-CCM pilot to characterize implementation experiences.
Methods: The PPP-CCM was implemented from November of 2020 through July of 2022. Formative evaluation team members observed implementation-related meetings and conducted multiple site visits, taking detailed fieldnotes. Fieldnotes were iteratively reviewed to identify barriers and facilitators to implementation and used to inform 7 key informant interviews conducted with programmatic staff at the end of the pilot. All data were analyzed using a Rapid Assessment Process (RAP) guided by the Consolidated Framework for Implementation Research (CFIR). The formative evaluation team shared results with program stakeholders (pharmacists, physicians, and other site staff) to verify and expand on learnings.
Results: Evaluation of PPP-CCM revealed 5 themes, encompassing all CFIR domains: 1) PPP-CCM was feasible but challenging to deliver efficiently; 2) the pharmacist role and characteristics (e.g., being flexible, available, and patient-centered) were key to PPP-CCM successes; 3) the PPP-CCM team met challenges engaging patients over time, but some team-based strategies helped; 4) community site characteristics (e.g., existing trusting relationships with PWID and physical space that enabled program visibility) were important contributors; and 5) financial barriers may limit PPP-CCM scale-up and sustainability.
Conclusion: PPP-CCM is a novel and promising approach to HCV care delivery for PWID who may previously lack engagement in traditional care models, but careful attention needs to be paid to financial barriers to ensure scalability and sustainability.
Competing Interests: Declarations of Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: J. Scott reports that in the past two years he has served as a paid consultant to Gilead Sciences for work related to COVID therapeutics and as a paid expert on the data adjudication committee for a cardiovascular medication made by Novo Nordisk. E. Tung discloses that she has served on Advisory Board and Speaker's Bureau for Gilead Sciences. Other authors declare no conflicts of interest.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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