Beyond the C: Hepatitis C Elimination in Your Practice is a comprehensive and incentivised model of virtual Practice support to facilitate active case finding, screening, testing and treatment of hepatitis C. Utilising a whole of practice approach, the project provides primary care practices with tailored support and education to build capacity to implement quality improvement activities and enhance hepatitis C care through clinical auditing. The aim of the project is to embed sustainable QI skills into routine practice, through a person-centered care framework, and increase the number of people identified for screening, testing, and treatment. Practices that we recruit are guided by our General Practice Nurse Consultant to utilise their Medical Software System for case finding and auditing. Project development commenced in September 2019 and is due for completion in August 2021.
ASHM has worked with 27 practices nationally to undertake a clinical audit and provide education around case finding, risk factors, testing and treatment for hepatitis C. Throughout the course of the project, ASHM staff have collaborated with a number of passionate individuals, engaged in remarkable work in their practice settings, to address this important public health issue. One such individual is Dr. Lakhbinder Kang, a 2nd Year trainee GPwSI (Aboriginal Health) at Derbarl Yerrigan Health Services in Western Australia. ASHM Project Manager Liv Dawson spoke with Dr. Kang, to talk about the goal of hepatitis C elimination, and his experience participating in the project.
“Why did you enrol in Beyond the C, why was the project appealing to you?”
“We had already started working on hep C, we had been working with WAPHA on a six-month project, but we hadn’t really fully put everything into practice. It’s also very rewarding, when there is a treatment available and you can clear the virus and people don’t get the awful consequences 20 years later of liver virus and things like that, it’s very rewarding to treat.”
”Has the process of participating in the project revealed anything to you that you weren’t anticipating?”
“Having ASHM behind you, it gives you that motivation and the incentive to actually make sure you do things to a really optimum level. I think that was another thing that was quite good in working with ASHM, because we know that we’re working with an organisation that is well recognised in the field. The first challenge was identifying the patients- that was the bit that took the longest - the rest was more just popping them into registers, recalling them, creating teams- the getting started took the most time. Another benefit that has come out of the ASHM audit is that we created a clinical item number for hep c clinical audit. 195 people were identified, and all have a clinical item for the ASHM audit, so if we want to do a future audit we will just run this report.”
“And in terms of outcomes, what have you been most proud of or pleased to see as a result of this project?”
I feel relieved almost to know, you know like, someone talks about hepatitis C and I think, I don’t know how many patients we have, I don’t know how many we’ve treated. So those were the two main questions I think ASHM has helped us to answer through this project, and to be sure, these are our numbers so that we have a baseline. Knowing that it’s not all chaotic, i.e. we don’t know the numbers, we don’t know who has it, have children been tested, that was always a worry for me, I feel relieved now…its not chaotic now, we can give you exact numbers and we know where we are going with it. It is a lot more organised and a lot more systematic and I’m really proud of that. “
“Would you say that within your practice, that this project increased understanding of the key clinical concepts related to hepatitis C management?”
“I think that they are a lot more confident to treat here now. We had a few who were referring out before, but I think now I’m getting the feeling that the GPs are a lot more confident in treating. We have the ASHM decision making tool in the DY library, everyone is familiar with it so we use that….but it (treating) doesn’t seem as complex anymore now.
If you had one piece of advice for other practices, why would you advise or recommend being a part of a project like this?
“I think I probably have more than one! It’s very rewarding and I think it’s like you’re preventing a serious disease, the patients are very engaging- it challenges us in a good way, challenges our assumptions, it’s not necessarily complex, treating hepatitis C is not as complex as perhaps we may have believed before. I think it is just a very rewarding chronic condition to treat, with significant rewards for both patient and clinician in the long term.
It’s also good for teamwork, what I’ve found is that we’ve created good teams in our clinic as we actually have doctors talking to one another…..it’s actually everyone talking, the Aboriginal Health Practitioners working together, we’re all talking about hep C and the whole clinic knows we’re working on hep C- you get the team momentum behind you….just people talking to each other and being enthusiastic about it! “
Dr. Kang and his team has been tirelessly working through the audit process, undertaking home visits to recall people for testing and treating. He noted that the identification through recall of people with hepatitis C, and individuals with liver cancer, demonstrated the importance of early diagnosis “it shows it is very real, we have to try every effort that we can to get a hold of our patients. (Treating hep C) sets a precedent for managing all other conditions like diabetes, heart disease, asthma and COPD etc- as we are trying to get hold of some of the more, well historically, those that have been thought of as being the most difficult to engage, but I wonder if that needs to be challenged as well.” The project will be evaluated, and a report disseminated following project completion in August.