Strategic Plan: Implementation and Recommendations

Medical and Case Management Focus Area

Overview

The overall goals of medical and case management of persons infected with viral hepatitis are to reduce the incidence of new infections of hepatitis and to limit the disease burden from chronic hepatitis.

During the last decade, much progress has been made in the prevention of hepatitis A, B, and C through improved recognition, aggressive testing and increased vaccination, especially in children. Therapies with antivirals and immune modulators have progressed over the last decade with research continuing. However, prevention and immunization remain the best defense against acute and chronic viral hepatitis.

In order to improve overall care to those infected, the clinical recognition of viral hepatitis must be improved. Although special populations may be at increased risk for disease, hepatitis is not limited to these populations. It is imperative that all physicians routinely question all patients for potential risk factors. At the same time, education can begin to provide the necessary information to prevent infection in those without hepatitis. Physicians must be informed of these risk factors and of the current management of hepatitis. Each year, the NYSDOH sponsors a hepatitis C conference for clinicians to provide updates on the most current information available, so they may effectively and efficiently manage patients infected with hepatitis C. Since patients with hepatitis are often co-infected with HIV, or are substance abusers, an added component to patient care is support services, including social and mental health support. Case management must be diligent and continuous so these individuals are not lost to follow-up and have the potential to improve their quality of life.

Therefore, developing a standard of care for providers would be helpful in managing disease. This standard would emphasize the need to address multiple patient issues ranging from ongoing medical care, vaccination, therapies and support services. These standards could improve access to quality health care providers and care and, as a result, improve current morbidity and mortality from hepatitis. The NYSDOH AIDS Institute has developed guidelines for the management of individuals co-infected with HIV-HCV. Other state agencies, such as DOCS and OASAS, also have existing guidelines for the management of individuals infected with hepatitis B and hepatitis C. These guidelines could serve as resources for the development of a standard of care.

Major Themes from the Hepatitis Summit

Participants at the Hepatitis Strategic Planning Summit identified the following major themes in the hepatitis medical and case management focus area:

  • Provide effective screening tools for providers
  • Develop a standard of care for viral hepatitis for providers,
  • Improve coordination among subspecialty providers for improved care to the patient,
  • Improve communication from health care providers and support service providers to patients,
  • Create communication channels to educate providers and consumers with regard to current diagnosis, treatment and essential services,
  • Promote intensive training on case management of individuals with co-existing disorders, and
  • Continue and promote hepatitis research to improve quality of life through disease diagnosis, management and therapy.

Long Term Goal # 1: To develop and establish standards of medical care and case management for those at risk for or infected with viral hepatitis.

Strategy # 1:

To create medical and social screening tools to identify at-risk people (including adults and children) and the possible need for testing, treatment, prevention and long-term care.

ACTION PLANS

  • During year one, NYSDOH should research current screening tools and evaluate their efficacy.
  • During year two, NYSDOH and a multidisciplinary panel should:
    • Assemble a panel of experts (e.g., academic, medical case managers, health care providers) to adapt and consolidate screening tools for various settings (e.g., HIV, STD, substance abuse) and
    • Field test screening tools.
  • During years three and four, NYSDOH and multidisciplinary panel should develop an education plan and disseminate for use.

Strategy # 2:

Convene a multidisciplinary panel of providers and consumers to create standards of care inclusive of medical and case management.

ACTION PLANS

  • During year one, NYSDOH should convene and develop a multidisciplinary panel (health care providers, social workers, case managers, psychiatrists, consumers, IDUs, and those released from prison).
  • During year two, NYSDOH and partners should review existing standards and practices.
  • During year three, NYSDOH and partners should identify gaps and modify, develop and adapt standards.
  • During year four, NYSDOH should collect and disseminate "Best Practices" report.
  • During year five, NYSDOH and partners should update standards and develop quality indicators for publicly funded health care facilities.

Strategy # 3:

Create communication channels to educate providers and consumers regarding diagnosis, treatment and essential services.

ACTION PLANS

  • During year one, NYSDOH should identify partners such as providers, consumers, health plans, trade associations, New York State Association of County Health Commissioners (NYSACHO), Hospital Association of New York State (HANYS) to assist with enhancing communications.
  • During years two through four, NYSDOH should identify and develop communication channels (i.e., letters, Web sites, newsletters, conferences, hotlines).
  • During year five, NYSDOH should disseminate a hepatitis referral directory to providers and consumers.

Long Term Goal # 2: To ensure vaccination and treatment of all patients and clients likely to bene . t from the current (best available) standard of care.

Strategy # 1:

Integrate and coordinate treatment providers and programs to facilitate patients to complete treatment.

ACTION PLANS

  • During years one and two, NYSDOH and partners should:
    • Explore funding opportunities for case management and
    • Develop and implement medical and case management education.
  • During years three and four, NYSDOH and partners should develop public education and peer education for high-risk settings.
  • During year five, NYSDOH should explore options for funding for those uninsured and infected with viral hepatitis, similar to AIDS Drug Assistance Program (ADAP).

Strategy # 2:

Promote treatment among those receiving substance abuse treatment and those incarcerated.

ACTION PLANS

  • During year one NYSDOH, OASAS, and DOCS should:
    • Develop a peer education curriculum,
    • Prioritize venues of education, and
    • Provide focused education on substance abuse and mental health to reduce the barriers to care.
  • During year two, NYSDOH, OASAS, and DOCS should:
    • Provide transition to Medicaid for persons released from high-risk facilities (e.g., prisons) and
    • Conduct "in reach" within high-risk facilities.
  • During year three, NYSDOH, OASAS, and DOCS should:
    • Fund and deploy the curriculum and
    • Conduct train-the-trainer programs for peer groups.
  • During years four and five, NYSDOH, OASAS, and DOCS should evaluate the impact that the curriculum has on treatment for substance abusers and those incarcerated.

Strategy # 3:

Provide hepatitis A and hepatitis B vaccines to all facilities serving high-risk groups.

ACTION PLANS

  • During year one, NYSDOH should:
    • Assess and determine vaccine need and availability in these facilities and
    • Develop public education materials (e.g., TV ads, pamphlets) in different languages.
  • During year two, NYSDOH should develop a vaccine distribution plan.
  • During year three, NYSDOH should implement the vaccine distribution plan.
  • During years four and five, NYSDOH should evaluate the plan.

Strategy # 4:

Promote treatment of hepatitis C by private providers.

ACTION PLANS

  • During year one, NYSDOH, Office of Mental Health (OMH), psychiatrists, OASAS, community based organizations and private providers should:
    • Develop a network to include psychosocial support management, substance abuse counseling and peer support for those receiving treatment,
    • Develop awareness of the network, and
    • Evaluate the use of the network (quality, accessibility).
  • During year two, NYSDOH, OMH, psychiatrists, OASAS, community-based organizations, and private providers should develop, disseminate and evaluate a chronic HCV disease management program.
  • During year three, NYSDOH and partners should analyze evaluations and make appropriate revisions to chronic HCV disease management program.
  • During years four and five, NYSDOH and partners should promote and market the disease management program throughout the state.