Hepatitis C Management Program
Program Type: Local Effort - Programs and/or activities that have not been evaluated but are identified by local programs as producing positive results.
This submission was collected as part of the Community Wellness Champion project.
What is the ultimate goal of your project (how do you want it to impact your community)?
To increase awareness about Hepatitis C in the community, increase risk assessment to aid in prevention, increase testing of high risk populations, providing a continuity of care and improving the over all health of patients with Hepatitis C.
What do you want participants to get out of their participation in the project?
To gain an understanding of Hepatitis C disease process. To build a partnership with their provider to prevent any long term effects of Hepatitis C through healthy lifestyle changes. To receive high quality of care and consistent management of the follow up and treatment of Hepatitis C. To look at Hepatitis C disease management provided by Winnebago P.H.S. as a part of the continuum of changes the will lead them to a healthy life style.
What are all of your project activities or services?
Health care program provided by the clinic (includes lab, follow up, screening, education and treatment). Testing of high risk groups and providing individual education. Then if the patient is diagnosed with Hepatitis C they will be entered into our Patients with Chronic Hepatitis C program, this program will follow them for 6 months providing education, clinical follow up and referrals to services that may be needed. Then we use a check list that provides two tracks from the 6 month mark: one to see if the patient meets all the criteria for treatment and if they don’t they will be followed yearly for check ups and labs to monitor liver health, they will also be invited to the community education classes and the patient support groups that are held in Sioux City (we will eventually have our own support group meetings in our community) The health educator will provide activities (classes, articles in the news paper) in the community and the Winnebago Learning Center to give an over all education about prevention and protecting the liver.
Where do the activities take place (i.e. school, church, health care facility)?
1. Hospital, 2. Clinic, 3. Health fairs, 4. Selected Community sites and learning centers
What is special about how you do your activities?
It focuses on the patient and the community all the components of the program are focused on providing education and making the patient an active participant in their own health care. We encourage the patient to improve their over all health status before we under take treatment. This allows the patient to personally make the changes in their life so that the changes can become a permanent way of life, thus improving the general health of all patients who are diagnosed with Hepatitis C.
Who is eligible to participate in or get referred to your project?
Anyone can come to the community education programs, ask to be screened and receive general education about hepatitis C and liver health. Those with positive tests will automatically be added to the Patient with Chronic Hepatitis C program to manage their follow up and general health care.
How do you recruit participants? If this is a community education or outreach activity, please describe the groups that you are trying to target?
We provide risk assessments and Testings in the community and the clinic, but we don’t recruit.
What communities have been involved in this project?
The Winnebago Community at this time, but we are working with Macy Health Clinic and with the Santee Health clinic to see if this program would work in there communities because we see a lot of their patients at our facility.
What programs and agencies does your project partner with?
We also are working with Walgreens Specialty Pharmacy to have them fill our Hepatitis C prescriptions, so the medication will not come out of our pharmacies budget. Roche Laboratories, they provided the test kits we use out in the community. I worked with the Nebraska State Health Department Hepatitis C Coordinator to achieve this in the beginning. Now Aberdeen Area Tribal Chairman Health Board (Ann Drubnik) will be ordering them through Roche so these home test kits will be available to all the service units. We have invited Macy and Santee clinic to use some of all of it. So we will have better communication and quality of care of their patients that are seen at our facility also.
How do the partners collaborate?
We are in the process of setting something up with Macy Clinic so they will do the education and clinic follow up that the program provides. They will use the guidelines for treatment to aid their providers to improve quality of care and long term follow up that these patients need. We are also sharing this program with Santee clinic. Walgreens will file the insurance and fill the medication that the doctor prescribed. They also provide 24 hour ask a nurse hot line, provide reminder calls to the patient when the prescription ready to be picked up and they will also provide some education on Hepatitis C treatment schedule and drugs. Roche assist with education activities for the staff per our request. Anne Drubnik will provide the test kits when requested for our community health fairs
How did you build these partnerships?
I contacted the DON and the PA’s that worked with Hepatitis C at Macy and Santee Clinics to see what their needs were and how this program could be put to use within there communities. We had meeting, teleconferences and they were updated at each step during the development of the program. I called around I.H.S. to see if any other facility was treating Hepatitis C. I then talked to the Roche representative for the area and found out how they were getting the medications filled without it going through their pharmacy. I then made contact with Walgreens representative and set up a meeting at our facility to discuss what programs they offered. I set up some educational programs for the staff with Roche representative. I requested the Home Test kits from the Nebraska State Health Department Hepatitis C program and then I realized that it would be beneficial for all the service units to have these kits available for their health fairs to increase testing of high risk populations in their community. I sent the information to Ann Drubnik at Aberdeen Tribal Chairman’s Board and asked her to request the kits from Roche through their scholarship.
What resources are available to the community or other programs from your program?
We have community education packet and power point presentation, fact sheets, and pamphlets that the people can take home or use during the education class. We have a complete manual on the Hepatitis C program that the other clinics can use. It contains: case-management, clinical guidelines, community testing program, community education program, Staff education program, fact sheets, and news paper articles.
In addition to the services that your project provides, do you also provide other resources for individuals or communities—examples include social marketing, education, outreach, and/or consultation?
Yes, we have articles that can be used in the news paper or news letters, the community educator provides education classes in the community and in the Winnebago Hospital Learning Center. We have pamphlets and fact sheets that are specifically made for our service unit as part of the education program that can be given out to the general public.
Where does the funding come from to support your program?
All the staff works within their scope of practice whether it is an I.H.S. program or Tribal program. Winnebago P.H.S. hospital provided the education material used in the clinic and the Tribal Health educator provides the community education supplies. The community test kits are from a scholarship from Roche Laboratories at no cost to the Tribe or hospital.
How long has this project been going on?
I started this project in February 2006 and we finally have a completed manual that has been approved on July 18, 2007. But we have been implementing some clinical guidelines pertaining to treatment, follow up and testing the education programs since January 2007. We have been having educational opportunities for staff since November 2006 (provided by myself and Roche representative). We started some case management for those who had already started on treatment from February to August 2007.
How did this project get started?
I was developing the Winnebago Tuberculosis program and I noticed that several of the patients had problems with the medication and then were found to have Hepatitis C after they developed liver problems from the medications. Also we were screening the prenatal’s, but really didn’t offer much in education and follow up. When I investigated the rates of Hepatitis C in our community, I found that we had over 140 patients with diagnosed Hepatitis C. There was no follow up or education except pamphlets focused on treatment. I also found that when the patients were started on treatment they had no follow up other then an appointment; if they did not show up at the treating physician’s office for their appointment, they received a phone call only. I also found that there was no follow up for those who could not tolerate the treatment or those who did not want treatment.
What are some accomplishments of success that were achieved with this project?
We now test all of the patients with positive Tuberculin Skin Test for Hepatitis C. We have provided education focused on liver health and healthy life style first and then discuss treatment. This allows the patient too fully understand the disease process and weigh the pros and cons of treatment.
What were some challenges on getting this project started or to keep going?
Because I am a Public Health Nurse working for the Winnebago Tribe it was difficult to get the I.H.S. staff to understand that I was writing this program from their prospective and it would be maintained by the Winnebago P.H.S. Hospital. It took a lot of time to develop this program because most Hepatitis C programs are treatment focused and I wanted our program to be education and healthy lifestyle first then treatment, so the program had to develop this program from the ground up.
Your Own Perspective
Why do you think this project has been successful?
All of the components that were developed stayed with in the job descriptions of the staff members involved. I did not leave the education up to one group, but expanded it so that the patients and community members received consistent education from a variety of sources. I also made every provider and nurse responsible for case-management and any follow up that a patient needs for Hepatitis C. This was done by providing detailed check lists and treatment tools so patient will receive high quality of care and the continuity of their follow up or treatment would not be compromised by staff changes.
What are you most proud of or excited about in terms of this project?
I am proud of the fact that with this program we will provide the best care to our patients and not overburden one group or one person during the process.
What advice would you give to someone trying to start a similar project in their own community?
Keep on track, there are so many obstacles that will come up during the development phase and even more during the implementation phase. You must be willing to seek out those whom you have to work with, this may mean using every opportunity to meet (seconds in the hall, 5 minutes on the phone, out in the parking lot, or just corner them in their office), either way you must be prepared and have specific questions because you may only get the one chance that week or even month to get it answered. Be flexible and mindful of the stress that the staff you maybe working with are under and know that you may have to step out of you comfort zone to get the job done.
Community, Clinic/Health Center, Hospital, Other: Health fairs
Healthcare Access , Infectious Disease
Name: LCDR Darla McCloskey, RN, BSN, PHN
Site or Location Name:
Phone: 402-878-2440 ext. 1232