Assessing the effectiveness of a new protocol for Hepatitis C-Genotype 1 Treatment for Veterans

Monday, 18 November 2013

Elizabeth Ann King, MSN, RN, CNL1
Bernadette M. Longo, PhD, RN, CNL2
Kimberly Baxter, MSN, RN, FNP-BC1
(1)Orvis School of Nursing, University of Nevada Reno, Reno, NV
(2)Orvis School of Nursing, University of Nevada, Reno, Reno, NV

Learning Objective 1: The learner will be able to describe how the new evidence-based treatment for Hepatitis C (genotype 1) can improve cure rates and lower attrition.

Learning Objective 2: The learner will be able to identify steps that a Clinical Nurse Leader can use to improve delivery of evidence-based practice by the healthcare team.

Previous treatment for hepatitis C infection (HCV) has been poorly tolerated by patients because of considerable side effects, and a long treatment time which provided only a 50% cure rate.  In 2011, the Veterans Administration approved the addition of Telaprevir or Boceprevir to the treatment regime of Peg Interferon and Ribavirin for Veterans with HCV genotype 1. The purpose of this Clinical Nurse Leader (CNL) project was to assess the effectiveness of the new treatment protocol provided by the treatment team in an outpatient microsystem.  A retrospective cohort design compared treatment outcomes from inclusive groups of Veteran HCVgen-1 patients (N = 59) for 20 months prior to start of the new treatment to 9 months time with the new protocol. Outcome measures included: viral load in the bloodstream taken at baseline and weeks 4, 8, 12, and 24; cure rates; total treatment time; and attrition.  Results revealed that although the new treatment cohort had over twice the viral load at baseline, they had a 9% higher cure rate (57% vs. 66%), more rapid decrease in viral load (p<0.001; negligible at 8 weeks), and less patient attrition. Moreover, a further comparison between cohort patients with first-time treatment for HCV showed a significantly higher cure rate of 86% with the new treatment protocol. Cost analysis of the new HCV treatment protocol estimated an additional $15,000-$37,000 per patient. Regardless, the new protocol is in alignment with the mission of the institution and improvement in clinical outcomes was attained. This evidence-based practice project demonstrates the utility of the emerging CNL role within today’s healthcare team.