Within the last month, AASLD*, IDSA** and IASUSA*** have collaborated to create an updated set
of evidence-based guidelines to give healthcare
providers a credible, non-biased reference to help
guide patient care.2 Current guidelines recommend
the collection of a HCV viral genotype to guide
regimen and length of therapy selection. The
healthcare provider must consider several additional
factors to support optimal outcomes, such as
comorbidities including co-infection with HIV, renal
impairment, depression, history of cardiac, thyroid,
transplant and/or autoimmune disease, interferon
eligibility status, hematologic and biochemical
indices, severity of liver fibrosis, previous response
to therapy, applicable genetic polymorphism
testing and age. These additional considerations
should be evaluated when determining clinical
appropriateness of treatment selection and length
of therapy.2 Pharmacists caring for HCV patients
have the responsibility of making sure these factors
are also part of their standard drug utilization review
and should collaborate with the prescriber on the
collection and review of the patient’s medical history.
Pharmacists in a specialty pharmacy setting are more
likely to have the ability to invest the time needed to
collect and document this information prior to the
patient starting treatment.
The most appropriate HCV regimen choice is
critical but patient commitment to therapy is equally
important towards reaching a positive outcome.
HCV therapies are often solely self-administered and
require strict adherence to therapy in order to reach
a SVR goal. A pharmacist should provide the patient
with support methods to improve adherence and
confidence with therapy. Prior to starting any therapy,
a pharmacist, the patient and/or the caregiver
should have a consultation session that focuses on
objectives to empower a patient to take responsibility
for management of their HCV therapy. Clinically, a
pharmacist would assess readiness for treatment,
evaluate the patient’s treatment expectations, gather
additional medical information and educate the
patient regarding proper medication administration,
storage and all potential side effects and how to
manage them. From a non-clinical perspective, it is
equally important to evaluate the patient’s support
system and need for additional resources before
therapy begins. This preliminary conversation helps
identify and remove potential barriers to adherence
but should also engage the patient to take control
of their healthcare needs. Motivational interviewing
techniques and the use of open ended questions
are often used by pharmacists to help identify
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adherence risk factors