Pharmacist-led pre-treatment assessment, management and outcomes in a Hepatitis C treatment patient cohort
- 4 Downloads
Background Medication reconciliation and drug–drug interaction management represent important patient safety processes completed by pharmacists as part of Hepatitis C patient care. Objectives To describe the pharmacist-led interventions of medication reconciliation and drug–drug interaction assessment, grading and management in a real-world Hepatitis C treatment cohort and to assesses the impact on patient outcomes. Setting Two Hepatitis C hospital outpatient clinics at St. James’s Hospital, Dublin. Method Patients treated with Hepatitis C direct acting anti-viral agents between December 2014 and February 2017 were included in this retrospective cohort study. The study employed a standardised medication reconciliation proforma and drug–drug interaction reference list. Main outcome measures Analyse medication variances identified during pharmacist-led medication reconciliation. Assess the prevalence, type and severity of drug–drug interactions between direct acting anti-virals and co-medications. Assess the rate of prescriber acceptance of the pharmacist-developed drug–drug interaction management strategies. Results Among the 300 patients in this study, medication reconciliation identified 1543 co-medications, with 71% of patients prescribed co-medications which were subject to a potential drug–drug interaction. Drug–drug interaction assessments assigned a rating of severe to 68 interaction episodes. At least one co-medication was stopped during treatment in 25% of patients to facilitate drug–drug interaction management. Pharmacist proposed management recommendations were accepted by prescribers in 96.9% of cases. The sustained virological response rate among the cohort was 92.7%. Conclusions In this Hepatitis C pre-treatment pharmacist assessment analysis, a significant number of medication reconciliation variances and clinically significant drug–drug interactions were identified which present unique and important patient safety risks. Pharmacist-led management strategies aided the achievement of optimum treatment response while promoting patient safety and antiviral stewardship.
The authors would like to acknowledge the co-operation of patients and staff at the Hepatology Department and the Department of GU Medicine & Infectious Diseases, St. James’s Hospital in the completion of this research project.
Conflicts of interest
MC has received research funding from the Irish Hepatitis C Research and Outcomes Network. CB has served as an advisory board member for AbbVie, Janssen, Gilead and BMS and has received research funding from Gilead and AbbVie. SN has served as a speaker, a consultant or advisory board member for AbbVie, Gilead, BMS, Janssen and Roche Pharmaceuticals and has received research funding from AbbVie.
- 5.AASLD-IDSA. Recommendations for testing, managing, and treating Hepatitis C. 2017. Available from: http://www.hcvguidelines.org.
- 8.Marra F, Leber W, Barclay ST, Christensen S, Ouzan D, Oules V, et al. High prevalence of co-morbidities and complex polypharmacy with drug–drug interaction (DDI) potential in patients with chronic Hepatitis C (CHC). Consistent findings from large primary care databases in the United Kingdom, Germany, and France. Hepatology. 2015;62:725A.Google Scholar
- 9.Maasoumy B, Zu Siederdissen CH, Marra F, Port K, Deterding K, Manns MP, et al. Prevalence of drug–drug interactions with modern interferon free antiviral regimens against Hepatitis C in a large real-world cohort. Hepatology. 2015;62:767A–8A.Google Scholar
- 11.Vermehren J, Peiffer KH, Welsch C, Grammatikos G, Welker MW, Weiler N et al. The efficacy and safety of direct acting antiviral treatment and clinical significance of drug–drug interactions in elderly patients with chronic Hepatitis C virus infection. Aliment Pharmacol Ther. 2016;44(8):856–65.CrossRefGoogle Scholar
- 16.Phillips M, Wilson JA, Aly A, Wood M, Poyah P, Drost S, et al. An evaluation of medication reconciliation in an outpatient nephrology clinic. Cannt J. 2016;26(2):29–33.Google Scholar
- 27.World Health Organisation. Guidelines for the screening, care and treatment of persons with chronic Hepatitis C infection. April 2014Google Scholar
- 28.Organisation WH. ATC/DDD Index 2016. In: Methodology WCCfDS; 2016. Available from: https://www.whocc.no/atc_ddd_index/.
- 29.Back, D. University of Liverpool HEP Drug Interactions. 2017. Available from: www.hep-druginteractions.org.
- 30.Micromedex Healthcare Series (database on CD-ROM) Version 5.1. Greenwood Village, Colorado: Thomson Reuters (Healthcare) Inc, 2007Google Scholar
- 31.Stockley’s Drug Interactions 9th Edition, 2009, London: Pharmaceutical Press.Google Scholar
- 35.Kiser JJ. Clinically significant drug–drug interactions between Hepatitis C virus and HIV treatments. Top Antivir Med. 2016;24(3):106–10.Google Scholar