The Cornish hepatitis C management model is an integrated model of care, incorporating partnerships between hospital-based hepatology and drug and alcohol services. Blood-borne virus (BBV) screening is performed in the community by all Addaction staff with each result reviewed by the BBV lead nurse. The BBV lead nurse then discusses the positive results with the patients and when ready for treatment takes each case to the monthly hepatology multidisciplinary meetings.
Addaction covers the whole of Cornwall with clinics in its own premises, GP surgeries, probation offices and pharmacies. The choice of treatment location is decided on where the patient lives and how accessible the service is to them.
Cornwall is both rural and urban. Injecting drug users were being asked to travel up to 40 miles each way for treatment, prompting poor attendance. BBV screening was poor, so DBST was introduced in 2011. This increased both screening numbers and new HCV diagnosis.
Viral hepatitis treatment was provided at RCH (Truro) with some outreach clinics. In 2008, Penzance was identified as an area of need, and in partnership with Cornwall Drug and Alcohol Team, Addaction set up a one-stop-shop to complement secondary care treatment.
Ten HCV patients from a Penzance general practice were treated by a GPSI, CPN and BBV nurse. Clinical governance was provided by secondary care hepatology and the BBV nurse subsequently offered a roaming nurse-led service.
The project has three objectives. The frst was raise the profile of BBV screening to patients and partner agencies across Cornwall. A business plan was put together to win funding for DBST kits, to roll out the DBST programme and give DBST training to drug and alcohol keyworkers. A DBST pathway was devised.
The second was to improve community HCT treatment, supporting hard to reach active injectors. A pilot project was to be set up in a GP practice for patients receiving substitute prescription for opioid dependence and a general nurse trained to manage HCV patients.
The final objective focused on multi-agency working, collaborating with partner agencies, discussing HCV patients at a monthly hepatology MDM and auditing patient outcomes annually.
Back to the top