The HepCare Model of Integrated Care improves clinic attendance in ‘hard to reach’ hepatitis C positive patients

Author: Nic an Ríogh E, McCombe G, Fawsitt R, McHugh T, O’Connor E, Stewart S, Swan D, Tinago W, Cullen W, Lambert J

Theme: Models of Care Year: 2019

Non-attendance at hospital out-patient department(OPD) appointments results in considerable loss
of capacity in health services. Among patients with HCV attendance is particularly challenging and
limits the capacity to support patients through the cascade of care. We previously estimated that only
48% attended two or more OPD appointments for assessment and treatment.
Description of model of care:
To address this problem, we developed an integrated model of care to support patients’ engagement
with specialist assessment and treatment that involved education of health professionals, peer
support and an outreach nurse specialist to liaise with general practices and other community based
health agencies.
This paper aimsto assess how this intervention impacted on specialist clinic attendance and treatment
rates over a 19 month period. Patients (N=96) referred to the Infectious Diseases and Hepatology
Clinics at MMUH through the ‘HepCare’ programme were identified from patient records, which were
reviewed by a member of the research team. The study population included all patients who were
allocated an appointment between 1st January 2017 and 31st July 2018. Attendance rates and
treatment commencement rates among this population were analysed. Semi-structured interviews
were also conducted with selected patients (N=4) to explore barriers and facilitators to attending
specialist HCV care.
In total, 500 clinic appointments were reviewed for 96 patients. 318/500 (64%) of these appointments
were attended with 68/96 (71%) of patients attending at least one appointment. Of the 96 referred,
30 (31%) commenced treatment during the study period. Facilitators of treatment included positive
interpersonal relationships, motivation and accessibility to treatment. Barriers to treatment included
competing priorities, fear of treatment, misinformation and denial.
As well as impacting positively on the number of patients who commenced treatment, the ‘HepCare’
intervention significantly reduced non-attendance at hospital appointments. It is a priority to evaluate
the indirect impact of such complex interventions when examining health service challenges.
Disclose of interest: None

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