Online Program

Taking the "fast track" to better care for opioid addicts with hepatitis c

Wednesday, November 6, 2013 : 1:30 p.m. - 1:50 p.m.

James Morrill, MD, PhD, MGH Charlestown HealthCare Center, Massachusetts General Hospital, Charlestown, MA
Christina Carr, MD Candidate 2014, MGH Community Health Associates, Harvard Medical School, Revere, MA
Ann-Marie Duffy-Keane, MPH, MGH Community Health Associates, Massachusetts General Hospital, Revere, MA
William Bean, PhD, MPH, MBA, Global Health and Population, Harvard School of Public Health, Boston, MA
Jean Bernhardt, PhD, RN/NP, MGH Charlestown HealthCare Center, Massachusetts General Hospital, Charlestown, MA
Sonia Burgos, MGH Community Health Associates, Massachusetts General Hospital, Revere, MA
Hepatitis C is the most common blood-borne infection in the U.S. and is the leading cause of end-stage liver disease and liver cancer. An epidemic of chronic Hepatitis C has emerged in our target community of Charlestown, MA as a direct result if IV heroin use. At the MGH Charlestown HealthCare Center, 3% of all adult patients and 43% of those receiving Suboxone-based opioid treatment are Hepatitis C positive. Major gaps in the care of Hepatitis C patients exist at MGH Charlestown, including a low rate of antiviral treatment (26%), incomplete rates of viral load/genotype testing and Hepatitis A/B vaccination, and a 45% rate of alcohol use. We undertook a registry-driven quality improvement project targeting Suboxone patients with Hepatitis C, a reachable group coming in regularly for addiction care. Using a rapid problem-solving methodology called "Fast Track" adapted at the Harvard School of Public Health, a group of interested clinicians, administrators, and patients was convened to tackle gaps in testing/vaccination, implement a registry, design a Hepatitis C evaluation tool, and develop educational materials. The registry was used to target Suboxone patients with Hepatitis C at the time of visit to: a) complete testing and vaccination; b) perform a standardized evaluation; and c) provide patient education. Within 120 days, > 95% of patients had undergone appropriate testing and vaccination, 70% had been evaluated and educated, and the rate of alcohol use had dropped to 26%.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Identify the most important gaps in treatment among Opioid Addicts on Suboxone maintenance treatment with chronic Hepatitis C. Describe how a patient registry can be used to track patients and overcome treatment gaps on a short (120-day) time frame.

Keyword(s): Hepatitis C, Drug Addiction

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Harvard Medical School student who has participated in multiple projects on the epidemiology and treatment of opioid addiction and chronic Hepatitis C at the MGH Charlestown HealthCare Center in cooperation with James Morrill, MD, Clinical Director of the MGH Community Hepatitis C Program, and Ann-Marie Duffy-Keane, MPH, Program Director at Community Health Associates of MGH. This work has helped support on-site antiviral treatment and population management at the MGH Charlestown HealthCare Center.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.