Title: Integrating care between Addiction and HCV Services Jan Tait Ninewells Hospital, Dundee
1Integrating care between Addiction and HCV
ServicesJan TaitNinewells Hospital, Dundee
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3Problems with specialist service
- High non -attendance rates (50 -60)
- Long waiting times
- Poor communication between primary and secondary
care and addiction services and HCV specialist
service - Inflexible referral to specialist Centre
- Ineffective follow up
- One clinic in main hospital
4Perceived reasons for lack of referral and
attendance
- Perception of clinic
- Lack of knowledge of illness
- Unsure reason for referral (no symptoms
- On going drug problems
- Lack of Treatment
- Myths about treatment
- Clinic Waiting Times
5Tayside Hepatitis C Managed Clinical Network
- Established Jan 04
- Health Board Area
- Dundee, Perthshire, Angus
- Primary and secondary care
- Staff from
- Specialist HCV service
- addiction service
- prison service
- social services
6HCV Managed Care Network
- Establish reasons for non-attendance
- Arrange meetings with Stakeholders -Drug workers,
GPs, Prison Staff, Ante-natal staff and GUM
clinic - Design new referral pathway to include
Multi-professional referral - Provide educational sessions
- Create accurate database
- Develop nurse led service and outreach services
7Service redesign
- Referral extended to all health care
professionals caring for patients with Hepatitis
C (drug workers, prison nurses, midwifes, socials
workers, homeless workers) - Nurse led clinic weekly (first appointment)
- Establish outreach clinics
- New referral pathway
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9Service redesign
Noranside Prison Outreach clinic
Outreach clinic Arbroath GP practice
Nurse led new clinic at Ninewells Hospital
Perth Prison Outreach clinic
Outreach clinic Perth Drug Problem Service
10Interventions to increase attendance
- Send copy of appointment to referrer (drug
worker, social worker, prison nurse) - Key worker explains need for referral
- Key worker accompany patient
- Send DNA letter to patient
- Contact by phone, text, e-mail
- Rebook appointments when referrer or client
contacts service - Send reminder letters/text
11Outcomes
- Increase in referrals
- Increase in attendance
- Increase in numbers treated
- 892 no referral
12Establishing a database
- Information on
- individuals who are HCV positive in region
- number who should be referred
- number who had been referred
- number who have attended
- number who have been treated
13Outcomes of database
- There were 1767 hepatitis C antibody individuals
identified. - 1331 (75.3 ) were male.
- (73.1) tested were aged between 16 and 39.
- 447 (25.2) of tests GP practice,
- 364 (20.5) in Prison service
- 328 (18.5) in hospital.
- Follow up HCV PCR was available on 1243 and 928
(74.6) were positive. - Transmission risk was known in 1304 of cases and
in 1122 (86) this was injecting drug use. -
14Outcome of individuals not referred to specialist
clinic Total 892
15137 in Tayside not referred
- 67 (48.9) are in contact with local drug
services - 6 (4.3) are currently in Prison
- 6 (4.3) are under the care of the Mental Health
Team. - 40 (29.1) had attended their General
Practitioner in the last 2 years - 18 (13.1) had no contact with Health Services
within the last 2 years.
16Non-attendance
- Decreased however still significant
- Most non-attendance was clients from drug problem
service - Study on reasons for non-attendance
17Qualitative study
- Semi-structured interviews (4075 mins)
- 12 participants throughout Tayside
- Literature review revealed reasons for non
attendance (poor relationships with health care
professionals, health low priority, poor
knowledge regarding illness and treatment
options, etc) - Focus of study changed to reasons for attendance
- All participants had attended clinic at some
point - Transcribed interviews examined to find common
themes
18Lack of individuals knowledge of HCV
- Caused by Health care professionals lack of
knowledge - Information given at diagnosis very poor
- Confusion over HIV/HCV
- No knowledge of treatment
- Myths about treatment
19Impact of health professionals lack of knowledge
- Did not understand need for referral
- Did not think disease serious / or fatalistic
attitude - Importance of knowledgeable health care
professionals
20Stigma and isolation
- Poor relationship with healthcare professionals
- Not entitled to care and treatment
- Would be judged because of drug use
- Relationships with family and friends, did not
want family to know diagnosis
21Motivation to seek care
- Positive influence of family and friends
- Knowledge of health care professional
- Encouragement by health care professional to seek
care - Knowing someone who had been at clinic and/or
taken treatment - Concerns about health, particularly in older
individuals - Being a parent
- Knowledge of treatment and outcomes
- Continuing drug use would be a priority
22Factors influencing access to care
- Supportive health care professionals
- Reminders, help with transport, moral support at
clinic - Practical help, clinic nearby, knowledge of
clinic, short waiting times - Outreach clinics not everyone liked clinic in DPC
- Knowing that they would not be discriminated
against
23Outcomes of study
- Improve information on HCV given at diagnosis
- Dispel myths about treatment improve patient
information - Improve education of health care professionals
- Develop the positive benefits of supportive
relationships with healthcare professionals
particularly drug workers - Motivation of individuals to address health needs
(stages of change). - Refer when at appropriate stage
- Increase motivation to seek care
- Implement other strategies to increase attendance
- Liaison outreach nurse specialist
24Conclusions
- Integrating care between addiction services and
HCV services improve outcomes - Managed clinical network assists with integration
- Increase access for patients from Substance
misuse services in Tayside - Increase numbers tested for HCV (blood spot
testing, testing included in initial assessment
and yearly if at risk) - Increase numbers in treatment
25Thank you for your attention