Program improves hepatitis C treatment access for new moms
'Meds to Beds' model brings specialist to patient's bedside after childbirth
A simple shift in where new mothers receive care is helping the fight against hepatitis C. By bringing infectious disease specialists to a mother’s bedside before she leaves the hospital, the women are much more likely to complete the life-saving treatment compared with standard referrals, a study reveals.
“We were seeing too many patients fall through the cracks simply because of traditional divisions between what was treated inpatient — labor and delivery — versus outpatient — hepatitis C,” Laura Marks, MD, PhD, the study’s senior author at Washington University School of Medicine in St. Louis (WashU Medicine), said in a university news story. “We partnered across departments to make sure that when pregnant patients come to Barnes-Jewish Hospital to deliver their babies, they have the option to also get care for a disease that, if left untreated, can lead to cancer.”
The study, “Association of Postpartum Inpatient Consultation Compared With Outpatient Referral With Hepatitis C Virus Treatment Completion,” was published in Obstetrics & Gynecology Open.
The hepatitis C virus, or HCV, is spread by contact with bodily fluids and causes inflammation in the liver that can set the stage for liver cancer.
Full treatment course to cure infection
Antiviral medications can treat hepatitis C, and a full course of them is usually effective for curing the infection. However, ensuring that all patients can access these treatments remains a challenge.
Worldwide, about one-fifth of people with hepatitis C are women of childbearing age. When pregnant women are found to have an HCV infection, the standard method of care is to refer patients to an outpatient clinic after they give birth.
However, visiting a separate clinic can be a big hassle for new mothers recovering from childbirth and caring for a newborn, causing many to miss out on treatment.
“Curing hepatitis C in these mothers has a huge ripple effect — it protects their health, their families and their future pregnancies,” said Jeannie Kelly, MD, a study author at WashU Medicine.
To help improve access to hepatitis C treatments, Marks, Kelly, and colleagues developed a “Meds to Beds” program. Essentially, it allowed mothers to be evaluated by an infectious disease specialist while still in the hospital after giving birth. That way, women requiring antiviral treatment could get a prescription without needing to go to a separate appointment.
“Our Meds to Beds program provides a pragmatic model for opportunistic HCV treatment of obstetric patients after delivery,” the researchers wrote. “Opportunistic treatment programs focused on labor and delivery hospital admissions can engage women who may have never participated in prenatal care and who might be unlikely to attend postpartum outpatient visits.”
This study tracked outcomes from 125 mothers who were referred for HCV treatment during pregnancy or while giving birth. In line with standard practices, most of the women received a referral to an outpatient clinic, but follow-up data showed that less than half actually made it to the outpatient appointment.
Thirty-three mothers received a consultation through the Meds to Beds program. In 30 of these cases, infectious disease doctors recommended antiviral treatment, and all left the hospital after giving birth with a prescription already written. All but two had the medications in hand upon leaving the hospital, and the remaining two had the medications delivered to their homes due to insurance requirements.
“This new study shows that simply bringing the medication to the patient’s bedside right after delivery dramatically reduces the number of patients lost along the way,” Kelly said.
Most completed full round of treatment
Overall, two-thirds of the women who participated in the Meds to Beds program completed a full round of HCV treatment, compared with about one-third of those referred to an outpatient clinic. Statistical analyses showed that women in the Meds to Beds program were nearly five times more likely to complete a full round of treatment.
“Engaging women in HCV care by providing [antiviral treatment] on discharge from labor and delivery was associated with higher rates of HCV treatment completion when compared with standard outpatient follow-up,” the researchers concluded.
They called for efforts to implement this type of intervention more broadly to help facilitate access to HCV treatment for new mothers who need it.
“We can’t be afraid to try a new model of care when what we stand to gain is better health for the whole community,” Marks said. “We’re teaching our trainees to treat what’s in front of them,” and “as they’re completing the program here, we’re seeing them get recruited to bring this successful model elsewhere. It’s a gradual process, but based on the success we’re already seeing, this momentum will continue to build over time.”
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