Program Description

Location

Located within the outpatient Gastroenterology/Hepatology Clinic at Eskenazi Health
Clinic is already well equipped with all necessary supplies and space
Clinic Hours: 8:00 AM- 4PM on Monday-Friday
Eskenazi Hospital is an urban hospital that has provided care to Indianapolis-area residents for more than 150 years
Public transportation can be easily utilized to access clinic

(1)

Staff

One full time pharmacist (1 FTE)
Utilize current clinic administrative staff
- Responsibilities including scheduling, reminder calls/ texts/ emails, prior authorizations, and other administrative tasks necessary
Utilize 1-2 pharmacy students on rotations

Referral Process

Encourage Eskenazi Health Gastroenterology/Hepatology practitioners to refer patients meeting the following criteria:
- Clinic will prioritize patients based upon clinical judgement
- Referral forms can be filled out electronically by providers and submitted through EPIC
- Providers can select can select the GI Clinic pharmacist and the reason for referral on the electronic form
- Once the referral form is submitted, the existing administrative team at the Gastroenterology/Hepatitis clinic will schedule the visit with the pharmacist

Billing Process

Facility fee code G0463 ($96.25 per visit)
As alternative billing method if not able to utilize facility fee: Incident-To 99211 Code ($18.93)

Length of Patient Visits

We will visit with patients initially and at least every four weeks. Frequency may differ depending on personalized medication regimen chosen (0,4,8,12 week visits)
Phone call recommended 2 weeks after therapy initiated to monitor patient compliance and possible adverse reactions they are experiencing
Most treatments regimens are 12 weeks in length
Initial visits will be 30 minutes in length
Follow-up visits will be 30 minutes in length

Pharmacist-Patient Interaction

Visit Documentation

Documentation of all visits will be done on Eskenazi electronic medical record (EPIC)
Referring providers will be able to stay informed on patient progression through EMR
Notes on all patients seen that day will be updated and available for provider review at the end of each clinic day

No-Show Plan and Non-Compliance Plan:

We will explain the no-show policy at initial visit
Due to the highly expensive nature of these medications and average treatment length of 12 weeks, the policy will be strictly enforced
Patients will receive a reminder call/text/email (patient preference) 2 days prior to appointment
If patient fails to show up, arrives more than 15 minutes late, or cancels less than 24 hours in advance for scheduled appointment, patient is considered a no-show, and appointment will need to be re-scheduled
A courtesy call will be made for no show patients
After 2 no-shows within a year, the patient will be dismissed from our clinic
We hope to work with highly motivated patients, but we will monitor for compliance. If we suspect any issues, we will try to figure out underlying causes.

Data Measures

Retrospective data (initial patient viral load) will be utilized to access our success
Treatment Responses
- Rapid virologic response (RVR) at week 4
- Early virologic response (EVR) at week 12
- End of treatment response (ETR): undetectable viral load at end of therapy
- Sustained virologic response (SVR): undetectable viral load at end of therapy and 24 weeks after treatment
  - SVR = cure
- Relapse: initial response but viral load detectable at conclusion of therapy
- Nonresponder: detectable viral load after 24 weeks of therapy
- Null responder: viral load never decreases > 2 logs after 24 weeks of therapy
- Partial responder: > 2 log reduction in viral load but detectable viral load after 24 weeks of therapy
Time to treat
Vaccination status
Patient compliance
Patient satisfaction
Ease of access to medications
Quality of life
Health care team satisfaction
Hospital admissions

Virologic Responses:3

Interventions

Drug-Interaction Screening
Medication Reconciliation including G3 note or Epic Charting
Insurance inquiry for medication selection, contacting insurance to confirm
Vaccination recommendations and reconciliations
HCV education and medication scripting including G3 note
Assistance in medication dosing, selection, titration, ordering (changed dosage form to be more tolerable)
Assistance with PAs/facilitation with nursing PA coordinator or MDs unsure of rejection reason
Recommendation for NS5A resistance testing for HCV treatment selection
Contacted pharmacy to begin refills, clarify quantity dispensed, determine copay/coverage

CDTM Protocol

Ability to recommend and adjust hepatitis C medications and gastroenterology medications based on current guidelines and physician recommendations
Ability to recommend lifestyle modifications
Pharmacist can order genotyping test and monitor the viral load
Pharmacist can order NS5A resistance testing
Ultimately, the pharmacist has the ability to use his/her best clinical judgement for any decision making within their scope of practice