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

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%.