The Mount Sinai Primary Care Hepatitis C Clinical and Research Program


The Mount Sinai Primary Care Hepatitis C Clinical and Research Program

 
 

Background & Goal

The Mount Sinai Primary Care Hepatitis C Clinical and Research Program (Hepatitis C Program) was designed to address the needs of an underserved patient population with a prevalence of chronic hepatitis C infection nearly 5 times the national average. An integral component of the academic primary care practice at the Icahn School of Medicine at Mount Sinai, the Hepatitis C Program serves patients who are drawn primarily from the surrounding communities of East and Central Harlem and the South Bronx. 

In addition to progression of their liver disease, the patient population most affected by hepatitis C has become increasingly chronically ill as they have aged, and requires closer and more specific follow up. Historically, social determinants of health resulted in this patient population being plagued with co-morbidities, behavioral health issues, social concerns, and substance use. These negative health factors, together with inadequate therapeutic agents, impaired the successful treatment of  hepatitis C. Up to 75%  of individuals with hepatitis C are unaware of their diagnosis. The goal of the Hepatitis C Program is to educate and screen at risk members of the community, link patients with chronic hepatitis C infection to care, deliver effective care and treatment through a holistic interdisciplinary practice that simultaneously addresses social determinants of health, and to transition patients to better care and improved population outcomes.

Program Description

In 2002, Dr. Gardenier designed a holistic and longitudinal program to meet the needs of patients, most of whom were ineligible for treatment by the standards of care at the time. Dr. Gardenier purposefully took a harm reduction approach, using a patient-centered, relationship-based nursing framework which engaged patients and offered assistance with any issue, either concurrently or as a lead-in to treatment. The program’s outreach team targets high risk populations in the community through linkages with community-based organizations and other care providers. The team seeks to educate, screen, and then link those in need of care to appropriate resources.

For More Information Contact:

Donald Gardenier, DNP, FNP-BC, FAANP, FAAN

Jeffrey J. Weiss, PhD, MS

jeffrey.weiss@mountsinai.org

(212) 659-8551
www.mountsinai.org/
https://prepc.org/
http://hepcure.org/

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Additional innovative support was provided by Dr. Weiss with his development of the Psychosocial Readiness Evaluation and Preparation for hepatitis C treatment (PREP-C; prepc.org) and HepCure (hepcure.org).  PREP-C is an online structured interview tool used to assess and increase patient readiness for hepatitis C treatment. HepCure is a resource center that includes a provider dashboard, patient app, tele-education, webinar series, and patient resources. Both are available online and have the goal of expanding awareness, linkage to care, and provider capacity to treat chronic hepatitis C across clinical settings. HepCure was developed in collaboration with Dr. P. Perumalswami (Mount Sinai Division of Liver Diseases) and Dr. A. Atreja (Mount Sinai App Lab).

Evidence of Success

The number of unique patients seen in the Hepatitis C Program over the fiscal year ending in July, 2015, was 295, an increase of 80% over fiscal year ending July, 2014. The outreach and linkage to care results from the Hepatitis C Program have also shown impressive increases in recent years, a trend that is expected to continue.  Of 40 patients in the program who initiated treatment during one review period, 80% had past substance use and/or mental health issues and nevertheless completed treatment at rates comparable to other populations, suggesting that comorbid patients can be managed effectively while on treatment in a primary care setting. In addition, the program demonstrated that depression did not predispose patients to treatment discontinuation. The program has served as a model duplicated throughout New York State under the grant funded initiative of the New York State Department of Health AIDS Institute to increase capacity for hepatitis C care and treatment. In addition, the program has received ongoing funding from the Robin Hood Foundation.