Nario Steffanie, Reynauld Benhur, Blacklaws Helen, Boden Sharon, Sud Rishi, Hawken Glenn, Singh Satbir, Herba Karl, Panetta James, Pang James
Gosford Hospital, Central Coast Local Health District Gosford New South Wales Australia.
JGH Open. 2021 May 20;5(6):669-672. doi: 10.1002/jgh3.12552. eCollection 2021 Jun.
Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection has resulted in high rates of successful disease cure; however, not enough healthcare providers are available to deliver treatment to the population living with chronic HCV. To demonstrate that a nurse practitioner (NP) model of care is non-inferior to specialist gastroenterologist (SG) management of HCV infection, as measured by sustained viral response at 12 weeks (SVR) after initiation of DAA therapy.
Retrospective cohort database study.
Single-center outpatient study, Central Coast Local Health District (CCLHD).
All patients with chronic HCV treated in the CCLHD Liver Clinic in the period 3rd March 2016 to 31st May 2019 were retrospectively analyzed. In this time period, a total of 1638 patients with chronic HCV had completed treatment. Seven hundred and thirty-four patients were excluded (733 pre-PBS listing for DAAs and 1 not treated with DAA). Nine hundred and four patients were eligible for the study, of which 541 were managed by an SG, and 363 managed by an NP.
Data were collected on patient demographics, genotype, fibrosis score, and presence of cirrhosis. Primary end point was number of patients achieving SVR.
Of the 904 patients treated with DAA, 764 (84.5%) achieved SVR. There was no statistical difference ( > 0.05) in achieving SVR between patients treated by an SP ( = 481, 88.9%) and those treated by an NP ( = 281, 77.4%).
An NP model of care is non-inferior to SG management of HCV infection, as evidenced by equivocal success in achieving SVR between the two treatment groups. Therefore, an NP model of care is a viable option in the era of DAA therapy for HCV infection. Ongoing investment into the delivery of NP care could increase treatment uptake of HCV, with the aim of decreasing overall burden of disease.
丙型肝炎病毒（HCV）感染的直接抗病毒（DAA）治疗已取得很高的疾病治愈率；然而，没有足够的医疗服务提供者为慢性HCV感染者提供治疗。为了证明在启动DAA治疗后12周的持续病毒学应答（SVR）方面，执业护士（NP）护理模式不劣于专科胃肠病学家（SG）对HCV感染的管理。
回顾性队列数据库研究。
单中心门诊研究，中央海岸地方卫生区（CCLHD）。
对2016年3月3日至2019年5月31日期间在CCLHD肝脏诊所接受治疗的所有慢性HCV患者进行回顾性分析。在此期间，共有1638例慢性HCV患者完成治疗。734例患者被排除（733例在PBS列出DAA之前以及1例未接受DAA治疗）。904例患者符合研究条件，其中541例由SG管理，363例由NP管理。
收集患者的人口统计学、基因型、纤维化评分和肝硬化情况的数据。主要终点是实现SVR的患者数量。
在904例接受DAA治疗的患者中，764例（84.5%）实现了SVR。由SP治疗的患者（n = 481，88.9%）和由NP治疗的患者（n = 281，77.4%）在实现SVR方面没有统计学差异（P>0.05）。
NP护理模式不劣于SG对HCV感染的管理，这两个治疗组在实现SVR方面取得了相当的成功，证明了这一点。因此，在DAA治疗HCV感染的时代，NP护理模式是一个可行的选择。持续投入NP护理可以增加HCV的治疗接受度，以减轻总体疾病负担。
