Retail Clinics Poised to Play Greater Role in Hep C Management

With projections of physician shortagesranging from 46,000 to 90,000 in the next decade, patients with hepatitis C virus (HCV) could be left with gaps in their care.

HCV is the most common chronic blood-borne infection in the United States. According to the CDC, an estimated 2.7 million to 3.9 million individuals have chronic HCV. As a growing number of payers cover HCV treatments for patients, convenient care clinicians will likely play a larger role in managing this population, so they’d do well to stay informed about HCV, its manifestations, and its treatments.

“I definitely think the retail clinicians can fill some of that void, at least in identifying the patients and potentially treating them if it’s a relatively straightforward case,” explained Jennifer Andres, PharmD, BCPS in an interview withContemporary Clinic.

Meanwhile,a recent studyinvestigated the efficacy and safety of HCV care by nonspecialists. They enrolled patients from 2 community health centers in Washington, DC, and separated them into 3 treatment groups:

• A nurse practitioner group
• A primary care physician group
• A specialist in infectious disease or hepatology group

Patients were treated with ledipasvir and sofosbuvir, and the primary outcome was unquantifiable HCV RNA viral load 12 weeks after the patients completed the therapy. The researchers found that the nurse practitioners achieved statistically the same rate of sustained virologic response as the specialists.

“I was not surprised by these findings, given the complex and specialized medical care that most nurse practitioners and physician assistants provide in the modern era,” lead study author Sarah M. Kattakuzhy, MD, of the Institute of Human Virology at the University of Maryland, toldContemporary Clinic. “Given the advent of simple therapeutic options, along with consensus guidelines, I do expect more nurse practitioners and physician assistants will care for HCV in community-based settings.”

By some measures, patients with HCV may even receive better care in the retail clinic setting than in the specialist setting.

“I think in the retail setting, [clinicians] can have a more direct, less rushed interaction with the patient,” Dr. Andres said. “In some cases, [clinicians] may have more information about the patient, such as what medications they’re taking and other characteristics that a specialist in one building who doesn’t speak to other providers wouldn’t necessarily know.”

HCV services offered in retail clinics have evolved over time, and there’s little reason to believe that evolution will slow any time soon.

“It’s definitely becoming more convenient,” Dr. Andres continued. “Patients can easily come in to ask questions or have insight given to them.”