Intensive work undertaken by the Pathfinder Stockport at the Pennine Care NHS Foundation Trust following an upgrade of its medical IT systems is driving forward best practice for the Hep C U Later programme.
The bold and ambitious NHS APA Hep C U Later programme was established to drive widespread implementation of established best practice pathways across all NHS APA members' services in its mission to eliminate Hepatitis C by 2025.
Using findings from analysis of its historical medical records, Pathfinder Stockport have been able to identify recommendations to improve, increase and extend the implementation of best practice for Hep C U Later programme and its members' community services.
Liz McCoy, Drug and Alcohol and Addictive Behaviours Lead for the Pennine Care NHS Foundation Trust, said: “After we upgraded the archaic IT system, we quickly realised that we had access to historic records for every adult that had been treated in the Stockport locality. It was all on paper and mostly handwritten, so we formulated a way to extract all the relevant information, which would inform the Borough’s Hepatitis C elimination plan.”
Liz engaged a cohort of people who had lived through old protocol hepatitis C treatment, alongside Pathfinder’s Nurse Consultant and representatives of the local Operational Delivery Networks, to identify key documents for each client and create a practical framework.
“After we upgraded the archaic IT system, we quickly realised that we had access to historic records for every adult that had been treated in the Stockport locality. It was all on paper and mostly handwritten, so we formulated a way to extract all the relevant information, which would inform the Borough’s Hepatitis C elimination plan.”
An experienced drug and alcohol worker interpreted data from 839 open cases, which included primary drug and alcohol pathways and the entire population was then segmented for risk and action.
The results from analysing this data found that many people are reluctant to engage with testing and treatments as they believe it is still the old onerous and intrusive treatment regime. Liz said: “While the service currently has a wide offer of testing, which does have a good uptake, there are still a number of people that decline it as they just don’t realise how easy the testing is and how much more user-friendly the treatment is now.”
The analysis also showed that simple harm reduction advice isn’t sufficient, especially among those with a high-risk profile who test negative and are now having to retest after re-exposure to infection risk. Liz said: “People in the primary drug pathway are unlikely to possess the information they need to make informed choices.”
“While the service currently offers a wide offer of testing, which does have a good uptake, there are still a number of people that decline it as they just don’t realise how easy the testing is and how much more user-friendly the treatment is now.”
“It is also evident that there is also a small, but very significant group, that had very high-risk exposure and needed to be tested quickly. This includes people with previous injecting behaviour who had not declared it in their recent risk history. These people are being contacted as a matter of priority.”
From these findings, further areas of work will focus on increasing education, particularly peer education, communication, and engagement for those people who need these services, enhancing the treatment offers, and peer to peer support.
Liz concluded: “The team are developing the Borough’s Hepatitis C elimination plan, which also includes an action treatment plan for each individual to reduce the rates of hepatitis C infection in the area. This means individuals can be tracked and analysed by risk and action.
“We have access to onsite testing and good treatment; the next step is to convince more reticent people that it is suitable for them.”