Treating Hepatitis C in Primary Care: The Nurse Practitioner's Role
Patients can be wary of hepatitis C treatment when they learn about the side effects.
I've been working now as a family nurse practitioner for a couple of years, and one of the most rewarding things that I've had the pleasure of participating in is the treatment of hepatitis C. Modern treatment for hepatitis C has improved the outcomes and experiences of patients, and oral tablet treatment options have made compliance much better than as little as 5 years ago.
Of all the things that we in primary care see on a daily basis, the ability to bring a patient into the office after 8 to 12 weeks of treatment and reassure them that they are cured is refreshing and rewarding. It really isn't often that I get to relate that a patient's chronic disease is gone. This is the main reason I got into this career: make a difference and deliver good news. It happens so very rarely in my practice.
I belong to a practice that uses a telemedicine program called the ECHO Project to coordinate treatment of hepatitis C among rural health clinics with a hepatologist from one of the big hospitals in the state capital. This coordination allows us in the rural community to bring specialized care that might otherwise not be available to our population. It really is an amazing opportunity that I'm glad to be a part of, but as I've gained experience and knowledge in the treatment of hepatitis C, I have realized that treatment of this chronic disease can be expanded to even more primary care providers. This would give us a shot at potentially eradicating this disease.
The modern drugs that are used in treatment, like Mavyret, Harvoni, or Epclusa, have simplified the dosing, treatment time, monitoring, and follow-up of hepatitis C care. Many of my patients who underwent treatment in the 1990s or early 2000s with Interferon will relate to how sick they felt during treatment. When I can get them treated with our modern drugs, they are amazed at the lack of side effects when compared to their previous experiences.
All of my patients have a common complaint of chronic fatigue. When I warn them that a common side effect of treatment is increased fatigue, this naturally makes many patients wary — heck, scared — of treatment. I provide encouragement that we're talking about 8 to 12 weeks of treatment, and if they can get through those tough weeks, the symptoms will improve when complete. Nearly every patient I've treated (over 115 in the last year alone) tells me upon completing treatment that this is the best they've felt in 20 years. That's great news and it is really a thrill for me every time I hear it.
I follow the guidelines of the American Association for the Study of Liver Diseases. There, you can find the guidelines and algorithms for the treatment of hepatitis C broken down by genotype and cirrhosis stage.