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

 

From left to right: Dr. Sunil Varghese, Lynn Vignola, Danielle Renaud, Dr. Curtis Cooper, Dr. Kim Corace, Miriam Muir, Jane Taylor, Mary-Ellen Arsenault, Benedicte Carriere, Dr. Gary Garber

Viral Hepatitis Clinical Program

[Contact: Lynn Vignola, lvignola@toh.on.ca]

The Ottawa Hospital and Regional Hepatitis Program provides care for over 4000 hepatitis C virus (HCV)-infected patients in Eastern Ontario and Western Quebec, Canada. We also follow approximately 750 hepatitis B virus (HBV)-infected individuals. Our multidisciplinary team maintains a focus on providing treatment for patients who face barriers to care including those living with HIV, mental health illness, substance abuse, poverty and language barriers. Our clinical and research teams are linked with other chronic disease medical disciplines including gastroenterology and hepatology, psychology and psychiatry, endocrinology and social work.

The Ottawa Hospital Viral Hepatitis Clinic

The Viral Hepatitis Team 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.

Following the Ambulatory Care Service Delivery Model, we centre the patient on these four 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
  • Basic patient information
  • Clinic information: Module M on the 2nd floor of The Ottawa Hospital-General Campus
  • Patient information prior to visit, list of medications, etc
  • Campus specific information: General on Smyth Rd, bus route and parking options

2. Access:

  • Triage of consults
  • Scheduling by our clerk
  • Registration when patient arrives at the hospital

3. Treatment and Therapeutic Intervention:

  • Assessment and treatment
  • Treatment will include comprehensive monitoring by the team
  • Self management support
  • Internal/external referrals to diagnostic imaging, laboratory monitoring
  • Our multidisciplinary team includes physicians, registered nurses, social workers, clinical pharmacy, psychology and psychiatry

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 and Regional Hepatitis Program seeks to reach, engage and decrease barriers to care for marginalized and ‚Äėhard to serve‚Äô individuals living with HCV and other liver diseases so as to increase their access to education, assessment, ongoing care, and treatment.

In striving to achieve this goal, our Outreach Worker works closely with a variety of community and social service agencies (shelters, clinics, community health centres, methadone clinics, substance abuse programs) serving this target population, connecting with individuals at 4 distinct stages of engagement in HCV care: those contemplating engagement, seeking referral, preparing for treatment and receiving treatment. Interventions are targeted to the individual’s stage of engagement and include provision of education, support in the referral process, accompaniment, case management, counselling, advocacy and referral services. The program’s goal is for these interventions to be community based, to the greatest extent possible.

It is important to note that 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 this patient population, which has proven invaluable in decreasing barriers for marginalized individuals.

Viral Hepatitis TeleMedicine Program

[Contact: Dr. Sunil Varghese, svarghese@toh.on.ca]

HBV and HCV affect more than 100,000 people in Ontario. As the regional referral centre for Eastern Ontario, The Ottawa Hospital and Regional Hepatitis Program evaluated over 4000 patients from the Champlain LHIN and Outaouais Region. With the renewed emphasis on screening the demand for ongoing monitoring and treatment is expected to increase in the coming years. To meet this demand The Ottawa Hospital and Regional Hepatitis Program launched the TeleMedicine Program in the June 2013.

The goals of the TeleMedicine Program are to provide comprehensive multidisciplinary care for patients outside of Ottawa; develop a research program focussed on clinical outcomes and quality assurance and; to foster community capacity for Hepatitis care. For the patient telemedicine services will provide timely and convenient access to specialized care as well as greatly reduce travel expenses and ensure less time away from work. The program is being developed in collaboration with the Ontario TeleMedicine Network. It is supported by a Clinical Outreach Nurse and the resources of The Ottawa Hospital and Regional Hepatitis Program. This year five specialized community based nurses will also be joining the team.

The Viral Hepatitis TeleMedicine Program is aimed at patients living outside of Ottawa but within the Champlain LHIN. However, we also include patients from Ottawa but who have difficulty accessing and attending clinics at The Ottawa Hospital. These patients will be able to use telemedicine to connect to The Ottawa Hospital and Regional Hepatitis Program via Community Health Centres and/or other community sites.

Viral Hepatitis Research Program

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

Our program consists of an internationally recognized research team which is actively involved in the development of effective, well-tolerated and safe antiviral therapies for HCV, HBV and HIV-viral hepatitis co-infection. Our world class research program focuses on the following key areas:

  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 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 Disease in HCV- HCV effects lipid and glucose metabolism. This contributes to the risk of fatty liver disease and diabetes. Our research group consisting of Infectious Diseases (Dr Curtis Cooper) and Metabolic / Endocrine (Drs Alex Sorisky, TC Ooi, Mary-Anne Doyle) researchers is conducting studies to understand how and why HCV alters these metabolic functions and how to correct them. We also are studying the metabolic changes created by the medications used to treat HCV.
  4. Observational Cohort Research- We evaluate the tolerability, liver toxicities, virologic activity, and immune restoration capacity of antiviral therapy in HCV mono-infection and HIV-HCV co-infection utilizing an Ottawa HCV cohort database. Dr Cooper and his team have established expertise in cohort research and collaborate with other HCV and HIV cohorts including the Canadian Observation Cohort (CANOC), 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.

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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Read about World Hepatitis Day - Ottawa Event