Viral Hepatitis Program: A Model of Care that Sets the Standard

 

Viral Hepatitis Clinical Program

[Contact: Roselyn Castaneda, rcastaneda@toh.ca]

The Ottawa Hospital Viral Hepatitis Program (TOHVHP) provides comprehensive multidisciplinary Hepatitis C (HCV) & Hepatitis B (HBV) care for Eastern Ontario, Western Québec and Nunavut. The program was created in 2000 in an effort to provide viral hepatitis care for marginalized patients. From the beginning, our team has maintained a focus on providing care for patients who face barriers to care including those living with HIV, mental health illness, substance abuse, poverty, language & geographical barriers. Since its inception, our program has cared for over 5000 patients. Our Telemedicine program has been particularly effective in providing a high level of care to patients residing in remote areas.

Over the years, the TOHVHP has emerged as a an international leader in HCV care. Our team includes HCV physicians, a psychiatrist, a nurse coordinator, an outreach & telemedicine nurse, clinical nurses, a pharmacist, a psychologist, a social worker and an outreach worker. In addition, we are linked with other chronic disease medical disciplines including gastroenterology and hepatology. The program is also supported by a robust research team.

 

The Ottawa Hospital Viral Hepatitis Clinic

The Ottawa Hospital Viral Hepatitis Program offers specialized HBV and HCV care in keeping with The Ottawa Hospital’s Vision to provide each patient with the world class care, exceptional service and compassion that we would want for our loved ones.

In keeping with the Ambulatory Care Service Delivery Model, we base patient care on four fundamental pillars: 1- Pre-Appointment, 2- Access, 3- Treatment and Therapeutic Intervention and 4- Discharge.

1. Pre-Appointment:

  • Communication with the patient, the referring physician or agency
  • Consultation process, including request for testing pre-appointment
  • Gathering of patient information prior to visit, list of medications, etc.
  • Clinic information; Module M, 2nd floor or The Ottawa Hospital – General Campus
  • Campus specific information: General on Smyth Rd., bus route and parking options
  • Triage of consult, assigned priority
  • Needs assessment in more complicated cases
  • Scheduling of initial visits by our clerk

2. Access:

  • Use of RN clinics ahead of initial consultation when required to reduce access wait times
  • Outreach worker support to assist with accessing our clinic
  • Non-stigmatizing approach to encourage patient access/engagement in our clinic
  • Telemedicine appointments scheduled when required in order to facilitate access to those living in remote areas.

3. Treatment and Therapeutic Intervention:

  • Medical assessment and treatment
  • Treatment includes comprehensive monitoring of the team, follow-up blood work, treatment adherence etc.
  • Assistance with treatment funding (insurance submissions, compassionate access, ODB coverage)
  • Internal/external referrals to diagnostic imagine, laboratory monitoring
  • Access to our multidisciplinary team: physicians, RNs, social workers, pharmacist, psychologist and psychiatrist.

4. Discharge:

  • Transition of care
  • Shared care
  • Discharge to referring physician
  • Follow-up appointments

Viral Hepatitis Community Outreach Program

The community outreach component of The Ottawa Hospital Viral Hepatitis Program seeks to reach, engage and decrease barriers to care for marginalized and “hard to serve” individuals living with HCV and other liver diseases. Our goal is to increase infectious and liver disease awareness and to provide access to education, assessment, comprehensive care and treatment.

In striving to achieve this goal, our Outreach worker and Outreach RN work closely with a several community and social service agencies (shelters, clinics. Community health centres, methadone clinics, substance abuse programs, detention centres) thereby serving our target population and connecting with individuals at four distinct stages in engagement of HCV care: those contemplating engagement, seeking referral, contemplating/preparing for treatment and receiving treatment. Interventions are targeted to the individuals’ stage of engagement and include provision of education, support in the referral process, accompaniment, case management, counselling, advocacy and referral services. Our goal is to provide community-based interventions to the greatest extent possible.

This type of care is possible due to the willingness of our community partners to work with our clinic to provide collaborative and largely community-based care to a target patient population. This has proven to be invaluable in decreasing barriers for marginalized individuals.

 

Viral Hepatitis TeleMedicine Program

HCV & HBV affects more than 100,000 people in Ontario. With Canada’s adoption of the WHO’s Viral Hepatitis Global Elimination Strategy, there is a renewed emphasis on education and screening. The demand for HCV care and treatment is therefore expected to continue on its upward trend. With the advent of universal access and the availability of safe and effective antiviral treatments, achieving a cure from Hepatitis C is now possible. We are treating and curing Hepatitis C now more than ever.

To meet this demand and to reach as many patients as possible, The Ottawa Hospital Viral Hepatitis Program launched the Telemedicine Program in 2013. Patients include those who reside outside of Ottawa but within the Champlain LHIN, patients residing in Nunavut and patients who reside in Ottawa but have difficulty accessing and attending clinics at The Ottawa Hospital. The latter group may access our services via telemedicine offered through community-based sites such as detention centres and community health centres.

The program’s goals are to provide comprehensive care for patients who cannot physically access our clinic, to develop a research program focused on clinical outcomes and quality assurance, and to support community capacity for Hepatitis C care. Patients are thereby able to access timely and convenient specialized care while significantly reducing travel time and expenses. The program was developed in collaboration with the Ontario Telemedicine Network (OTN). It is supported by a Clinical Outreach Nurse and the resources of The Ottawa Hospital Viral Hepatitis Program.

 

Viral Hepatitis Research Program

[Contact: Dr. Curtis Cooper, ccooper@toh.on.ca]

  1. HCV Mono-Infection Antiviral Development- We have a vast experience in the Phase I-IV clinical development of antiviral medications for HCV which is transforming the way we treat and cure HCV.
  2. HIV-HCV Co-Infection- We have established expertise in HIV-HCV co-infection research focused on the development of new therapeutic agents; metabolic disorders and liver disease; and the delivery of treatment that maximizes safety, adherence and safety. We are also leaders in pharmacokinetic research and drug interaction studies.
  3. Metabolic and Immune Function in Liver Disease- HCV and HBV effects lipid and glucose metabolism as well as influences immune function. This may contribute to the risk for multiple diseases. Our team consisting of Infectious Diseases (Dr Curtis Cooper), Liver (Drs Cynthia Tsien, Erin Kelly) Metabolic / Endocrine (Dr Mary-Anne Doyle) and Basic Science (Drs Angela Crawley, Seung-Hwan Lee, Erin Mulvihill) researchers is conducting studies to understand how and why HCV and HBV alter metabolic and immune function and how to correct them.
  4. Observational Cohort Research- We evaluate the tolerability, liver toxicities, virologic activity, and immune restoration capacity of antiviral therapy in HCV and HBV infection utilizing an Ottawa cohort database. Dr Cooper and his team have established expertise in cohort research and collaborate with the Canadian Observation Cohort (CANOC), the Canadian HBV Research Network, CanHepC, the Canadian HIV Trials Network HIV-HCV Co-Infection Cohort, and the Ontario HIV Treatment Network Cohort Study. Our cohort research in metabolic complications of HCV complements our clinical and laboratory-based activities.
  5. HBV- Many promising new treatments for HBV are on the horizon. Our program continues to play a leading role in developing these medications today for better treatments tomorrow.

Why is this important?

This research informs patient care and improves therapeutic outcomes for liver and metabolic disease. This proactive research program may help avoid the types of metabolic complications witnessed during the early era of HIV combination antiretroviral treatment.

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