Academic journal article Australian Health Review

Exploring the Need for Hepatology Nurses and Allied Health Professionals in Victorian Liver Clinics

Academic journal article Australian Health Review

Exploring the Need for Hepatology Nurses and Allied Health Professionals in Victorian Liver Clinics

Article excerpt


Objective: To examine the need for hepatology nurses and allied health professionals in Victorian liver clinics to meet the increasing demand from people seeking treatment for hepatitis C infection.

Design: We reviewed the literature, analysed data from nine Victorian liver clinics, and conducted a qualitative rapid assessment with key stakeholders including hepatology nurses.

Participants: Fourteen key stakeholders including clinicians and directors of liver clinics were invited to take part in interviews; two declined to participate. All ten members of the Victorian Hepatology Nurses Group were invited to participate in a focus group discussion, and six attended.

Results: Participants reported that hepatology nurses played a critical role in improving treatment uptake and compliance, in particular, in educating, counselling and managing treatment for people with hepatitis C infection. Psychiatric and social work staff assisted patients to overcome side effects associated with treatment. Interpreters increased access for those from culturally and linguistically diverse communities.

Conclusions: Hepatology nurses and allied health professionals are central to enhancing treatment outcomes for people who are infected with hepatitis C. Further research is necessary to estimate the number of nurses and allied health professionals required to meet the current and future needs of people receiving treatment for hepatitis C infection.

Aust Health Rev 2006: 30(2): 211-218

HEPATITIS C VIRUS (HCV) is a prevalent flavivirus responsible for the vast majority of cases of viral hepatitis1 and can lead to chronic hepatitis, with an estimated 75% of affected individuals becoming chronic carriers. Twenty-five per cent of chronic carriers are at risk of developing liver cirrhosis within 20 years, and a quarter of those with cirrhosis will develop primary liver cancer within a further 5 to 10 years.2 The burden of HCV is difficult to estimate because the condition is chronic and largely asymptomatic until cirrhosis and end stage complications develop. Modelling suggests that around 210000 Australians are currently living with HCV with about 16 000 new infections each year.3 The number of people infected with HCV is expected to continue to increase, with an estimated 321000 to 836000 Australians predicted to be living with HCV by 2020. Based on these figures, it is anticipated that there will be a threefold increase in the number of people living with HCV-related cirrhosis and in the number of HCV-related deaths by the year 2020.3

An estimated 80% of infections in Australia are acquired through injecting drug use.2 People who inject drugs are often marginalised and reportedly experience difficulties in accessing mainstream health and social services.4 There is evidence to suggest that individuals accessing HCV treatment have been dissatisfied with their care, reporting communication difficulties, feelings of abandonment or being misled and feeling stigmatised by their physician.4

Pegylated interferon injection self-administered once a week in combination with oral ribavirin twice daily is an improvement in therapy which was listed on the Pharmaceutical Benefits Scheme (PBS) in November 2003.5 Sustained viral and histological responses to therapy translate into long-term remissions with potential reversal of fibrosis and a reduction in the incidence of liver cancer.6 However, the current treatment has serious side effects including fatigue, influenza-like symptoms, myalgia, nausea and/or vomiting, weight loss, reversible hair loss, injecting site irritation, insomnia, bone marrow suppression, and major depression including suicide attempts.7 Not all patients complete their course of treatment,8 and in 2003 only 1500-2000 of the 30000 individuals eligible for governmentfunded treatment accessed it through the PBS.9 Nevertheless, the advances in treatment and the anticipated increase in demand will pose numerous challenges for tertiary public hospitals where the majority of liver clinics are situated. …

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