Journal Club Spotlight: Expanding the care team to improve drug adherence

March 2012   Comments

Rodis, J. L., & Kibbe, P. (2010). Evaluation of medication adherence and quality of life in patients with hepatitis C virus receiving combination therapy. Gastroenterology Nursing, 33(5), 368-373. doi:10.1097/SGA.0b013e3181f443cb

The purpose of this study was to assess the impact of an interdisciplinary model of care on medication adherence during the first three months of therapy for patients with hepatitis C virus (HCV) and to determine the relation between adherence and quality of life. Patients, who were already receiving care from an NP, were given training on medications and had monthly monitoring phone calls from a pharmacist. They expressed satisfaction with the care provided under this model and reported taking 99.8 per cent of total interferon and ribavirin doses during the course of the study.

The journal club chose this article because of the changing landscape of HCV treatment; boceprevir and telaprevir, two new oral drugs in the protease inhibitors class, were recently approved in Canada and will be added to the current regimen of medications taken by patients. The overall cure rate for HCV has been about 50 per cent with a regimen of weekly injections plus four to six pills per day. An estimated 10 per cent to 20 per cent of patients do not complete treatment because of side effects and difficulties with adherence. Cure rates have been shown to increase with the addition of the new drugs, but patients will need to take an additional six to 12 pills at specific times of the day. Careful adherence becomes even more crucial for ensuring positive outcomes.

Colina Yim, an NP specializing in hepatology at Toronto Western Hospital Francis Family Liver Clinic, led a group of 10 nurses in assessing the study. The clinical setting for the study was a gastroenterology office, whereas most of the club members work in academic hospitals. However, two were liver nurses who work in small communities or health centres similar to the one described in the paper. These nurses expressed interest in the idea of bringing a pharmacist into the loop to improve drug adherence among patients.

“One of the nurses’ roles in the treatment of hepatitis C is to optimize patients’ responses. We know non-adherence is likely to be a barrier. Collaborating with pharmacists is one way to reinforce the counselling we do with patients,” says Yim.

“Pharmacists often alert me to an issue long before the patient is scheduled to see me. Most of my patients have memory problems, and a pharmacist is yet another reminder to them about what they need to do,” says Keri Trahan, who is a hepatitis C treatment nurse at the AIDS Committee of North Bay and Area. Overall, the group agreed that pharmacist involvement was a positive step.


NurseONE resources on this topic

e-Therapeutics

  • Gastrointestinal Disorders: Viral Hepatitis. (Rev. May 2011)

STAT!Ref

  • Dale, D. C. (Ed.) (2011). Infectious diseases: The clinician’s guide to diagnosis, treatment, and prevention.

EBSCO-CINAHL full-text articles

  • Traynor, K. (2011). HCV protease inhibitors bring new options for patients. American Journal of Health-System Pharmacy, 68(15), 1372-1379. doi:10.2146/news110051
  • Pears, E. (2010). Hepatitis C virus infection: Risk factors, diagnosis and management. Nursing Standard, 25(15-17), 49-56.
  • Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares? Mayo Clinic Proceedings, 86(4), 304-314.

The Liver Journal Club at Toronto Western Hospital Francis Family Liver Clinic is led by Colina Yim (colina.yim@uhn.ca). Members include nurses and liver research coordinators from Toronto Western Hospital, Mount Sinai Hospital, Toronto General Hospital, AIDS Thunder Bay and the AIDS Committee of North Bay and Area.
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