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. 2017 Sep 28;6(1):46.
doi: 10.1186/s13584-017-0172-1.

Multi-disciplinary Patient-Centered Model for the Expedited Provision of Costly Therapies in Community Settings: The Case of New Medication for Hepatitis C

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Free PMC article

Multi-disciplinary Patient-Centered Model for the Expedited Provision of Costly Therapies in Community Settings: The Case of New Medication for Hepatitis C

Nitzan Avisar et al. Isr J Health Policy Res. .
Free PMC article

Abstract

Background: In January 2015, the first interferon-free direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection was approved for inclusion in Israel's national basket of health services. During 2015, HCV genotype 1 patients with advanced liver fibrosis (stage F3-F4) were eligible for treatment with ombitasvir/paritaprevir/ritonavir and dasabuvir (OMB/PTV/r + DSV) provided through the four national health plans. As all health plans committed to identifying eligible patients nationwide, risk-sharing agreements created an additional incentive to develop an innovative model for rapid treatment delivery.

Aim: This article aims to describe the development and implementation of a multi-disciplinary patient-centered model for the expedited provision of costly therapies in a community setting, based on experience delivering new HCV therapy in 2015.

Methods: We present the case of the Central District in Maccabi Healthcare Services (MHS), one of five districts in a 2-million-member healthcare provider. We describe the dimensions of the model and its implementation, including the composition and responsibilities of the multi-disciplinary team, screening for patient eligibility, provision of care, and barriers and facilitators identified at each stage.

Results: The experience of the MHS Central District indicates that good communication between all stakeholders was the key driver of successful implementation of the model. Overall, monthly treatment uptake increased following the intervention and by the end of 2015 a total of 99 patients were treated with OMB/PTV/r + DSV in this district. Early data indicate high effectiveness in this population and evaluation in ongoing.

Conclusions: This multi-disciplinary patient-centered model enabled rapid integration of screening and disease staging to identify and treat eligible HCV patients in the MHS central district. The model forms the basis of the 2017 project to deliver DAAs according to broader health basket criteria and may be adapted for the provision of other innovative health technologies in different healthcare settings.

Keywords: Access; Community –national health policy; Direct-acting antiviral (DAA) therapy; Health care delivery; Health services management –primary care; Hepatitis C virus (HCV); Israel; Patient-centered care.

Conflict of interest statement

Ethics approval

The study was approved by the Institutional Review Board of Assuta Medical Center in Israel.

Consent for publication

Consent to participate was not needed as this was a retrospective observational study describing a model and its implementation at the district level, without the use of individual patient data.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient-centered model: composition of the multi-disciplinary project team
Fig. 2
Fig. 2
Uptake of OMB/PTV/r + DSV in the MHS Central District in 2015 before and after implementation of the patient-centered model

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