Need for Specialists in Smaller Facilities/Less Populated Areas
In addition to the cost concerns, the fact that specialists are in short supply, remains a problem, according to the article, which makes improving access to primary care for veterans harder to implement. VA medical centers are using telehealth consults to address staffing issues in rural areas as well as less populated cities. Alexander Monto, MD, director of the liver clinic at the San Francisco VA Medical Center explains, “We can treat patients from San Francisco, but they don’t have to come to San Francisco.”
In addition, through its Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO), the VA will provide smaller facilities with HCV training that will entail videoconferencing. The training will consist of a weekly or biweekly lecture on HCV where physicians, clinical pharmacists, and nurses can share patient information as well as receive feedback from other experts in the field. Research from the JAMA
article showed that through this training, physicians were able to significantly cut the time from treatment to diagnosis, (2 years for those without training and only 6 months for those who had it).
Increased Screening Needed
Another priority is increasing screening of veterans for HCV. The VA has been focusing on screening all veterans who had been born within the baby boomer generation, due to the recommendations
provided by the CDC. Electronic health records assist in checking if veterans born within that time frame have been screened for the virus and if it finds that they have not, it issues a reminder to be tested. A quarterly performance list will be published by each VA region to see if they have effectively met their individual goals. According to the JAMA
article, 70% of veterans born within that time frame had been screened by the end of last year, showing 7,400 new identified infections nationwide.
Another tool being utilized by the VA is a hepatitis C dashboard, updated daily, which has data from electronic medical records of patients. “The tool allows [Timothy Morgan, MD, chief of hepatology at VA Long Beach (California) Health System] and colleagues to sort through patients by hepatitis C genotype, extent of liver disease, treatment status, and other factors.” With this information, they were able to invite HCV-infected veterans with advanced liver disease who had not previously been treated to come in for treatment.
Continuing Education & Monitoring of HCV
The management of ongoing monitoring and additional education on HCV poses another challenge. In order to continually monitor diagnosed cases, the San Francisco VA Medical Center holds monthly group visits where 4 to 8 veterans each get their blood drawn, receive a 30-day supply of medication, and discuss test results in a supportive environment amongst their peers. In addition, they will have the opportunity to voice any emotional issues that they are experiencing to a psychologist as well.
Veterans who have a history of substance abuse are not excluded from treatment at the VA. In fact, the VA has experience in addressing the needs of these individuals through addressing various issues that can negatively impact medical treatment. An important factor that needs to be addressed is the stigma that is associated with HCV, that people who have it must have been “drug addicts” or “lazy good-for-nothings,” a common misconception of Vietnam veterans when they returned home from war. Due to this stigma, some people avoid being tested. Through continued education and addressing these issues, more people can get the treatment that they need.
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