One component of a new federal action plan for controlling viral hepatitis calls for expanded delivery of hepatitis A and B vaccines through pharmacies, beginning in 2013. Pharmacists are well situated to carry out the plan's vaccination and treatment goals by identifying at-risk patients and managing side effects for those receiving new therapies.
Pharmacists have played a key role in flu vaccination in recent years, particulaity during the HlNl epidemic. That initiative showed that pharmacies are good locations to vaccinate people, said John Ward, MD, director of the division of viral hepatitis of the Centers for Disease Control and Prevention.
The action plan, titled "Combating the silent epidemic of viral hepatitis: Action plan for the prevention, care, and treatment of viral hepatitis," was developed by the U.S. department of Health and Human Services (HHS). It was written in response to an Institute of Medicine (IOM) report on hepatitis, which last year described hepatitis as an unappreciated health concern.
The 2010 IOM report revealed that approximately 15,000 Americans die each year from liver cancer or liver failure attributed to viral hepatitis infections. It also indicated that most of the 3.5 to 5.3 million people in the United States living with chronic hepatitis B or C infection are not aware that they have it.
The action plan which calls for new and better-coordinated efforts to manage viral hepatitis, is divided into 6 areas of concentration:
* Education of providers and communities to reduce disparities in healthcare
* Improved testing, care, and treatment to prevent liver disease and cancer
* Strengthened surveillance to detect transmission and disease
* Elimination of vaccine-preventable disease transmission
* Reduction of viral hepatitis caused by drug-use behaviors
* Reduction of healthcare-associated transmission of viral hepatitis
The plan was published shortly before the approval of 2 new drugs for hepatitis C - telaprevir (rndvek, Vertex Pharmaceuticals) and boceprevir (Victrelis, Merck). According to FDA, both medications can significantly increase patient response and have the potential to decrease treatment duration.
During an interview given when the document was released, Dr. Ward termed pharmacists key educators of doctors, saying, "As these new drugs come online, [pharmacists] are going to have to play a critical role in educating providers in how they are appropriately used. These are complex drugs that bring a host of new management questions to the fore regarding resistance, when to initiate treatment, and how to monitor treatment and bring these drugs together."
The action plan suggests that some healthcare providers who treat at-risk patients fail to address viral hepatitis, which often results in cases of chronic liver disease and death that could be prevented. Increasing provider awareness of viral hepatitis is essential to improving the delivery of preventive services, testing, and treatment options, and is a goal of the plan.
The action plan states that "Clinicians who treat patients with viral hepatitis will need guidance regarding use of more effective but more complex regimens, including decision support tools (e.g., standing orders, electronic physician reminders, and telemedicine consultations)."
The action plan does not specifically address the role pharmacists can play in preventing, treating, and educating patients about viral hepatitis, said Juliana Chan, PharmD, who conducts research in hepatology at the University of Illinois at Chicago. …