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Hepatitis C support (Tairāwhiti)


Overview

A public campaign to eradicate hepatitis C in Tair?whiti commenced on 25 June 2018. 

Patients identified as being at risk of being hepatitis C positive are able to be screened at a range of service providers. If any of these patients are hepatitis C antibody positive they will then engage with general practice in order to have further testing and possible treatment initiated.

General practice will be supported to identify and test these patients and initiate a treatment plan following a positive diagnosis. The support will take the form of education, resources, electronic tools and funding to ensure there are no barriers to this group of patients accessing care.

Patient pathway

Patients who have a positive antibody test (whether by point of care testing or venepuncture) will need to have a PCR (viral load) blood test. If this is positive, they will need to be referred for a Fibroscan and have a genotype test in order to determine the course of treatment.

Patients with no or minimal fibrosis on Fibroscan AND those who are genotype 1a or 1b will be referred back to general practice for the prescription of treatment. All other patients will be managed in secondary care. View the patient pathway flowchart here.

Eligible patients

Patients who have one of the following risk factors:

  • ever injected drugs (once is enough)
  • received a blood transfusion, or blood products, prior to 1992 (in New Zealand)
  • lived, or received medical treatment, in high-risk countries (South East Asia, China, the Middle East, and Eastern Europe including Russia)
  • received a tattoo or body piercing using unsterile equipment
  • ever been in prison
  • born to a mother infected with hepatitis C.

In addition a list will be provided to general practices of their enrolled patients who have previously had a positive antibody result. This will enable practices to recall these patients. 

Service delivery

The service funds one initial contact, a maximum of two extended consults and one extended GP consult per patient. View the patient pathway flowchart here.

The initial contact may be by phone or face to face and includes discussion with the patient about the service and the condition. The antibody test result needs to be recorded. If this has been done elsewhere, the result is still to be recorded on the practice's patient management system.

An extended (30 minute) consultation is indicated if the antibody test is positive. This consultation is to include recording of the PCR/genotype result and referral to Fibroscan, if this has not occurred.

If treatment is to be initiated in primary care, as advised following the Fibroscan, an extended prescriber consult (30 minutes) is required to prescribe treatment. 

If treatment is prescribed, phone calls are required to check adherence and the impact of any side effects. Repeat blood tests are also required.

A second extended (30 minute) consultation with the patient is required 12 weeks after the completion of general practice prescribed treatment. At this consultation, the repeated PCR/genotype result is to be recorded.

Claiming guidelines

Provider agreements will be sent to practices. Once the practice has agreed to be a part of the service a claim form will be loaded into their PMS. Submission of the form will generate a claim. Completion of the claim form is sufficient documentation to lodge a claim. The patients' clinical notes in the PMS need to reflect the care provided.

FAQs 

Does the patient have to pay? 

There is no charge to the patient.

Does the practice need to phone for approval to lodge a claim? 

No prior approval is required.

Additional patient funding

Anyone with a community services card can apply to WINZ for a special grant to assist with their treatment costs. They do not need to pay this money back. They require confirmation of the fact they are eligible for hep C treatment along with an indication of travel costs to access the GP. This can also cover any additional GP visits beyond the funded consultations provided by this service.

For more information

Contact Pinnacle MHN Physically Well programme lead Sally Newell.

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