Claire Munro Co-facilitator London Joint Working Group on Substance Use and Hepatitis C The role of technology in supporting patient pathways

Apologies Victoria Leenders, BBV Borough Lead & Nurse Islington Drug & Alcohol Services and Naomi Glover, Viral Hepatitis CNS at University College Hospital and The Royal Free We can do anything if we all pull together

Victoria and Naomi work together to: Reduce DNA rate & make hepatitis C treatment more accessible Improve rates of access to HCV follow up and treatment Develop a patient-focused service

Pathway & outcome findings 1/3 of patients referred did not attend their hospital appointments...

Hard to reach? “We need to consider: are the groups at risk from hepatitis C ‘hard to reach’ or are our services ‘difficult to access’?” Dr Helen Harris, Public Health England

Street Talk Home Office funded project for young people Used a mobile app Drug treatment and community organisations and across twenty sites in England The Crime Directorate in the Home Office and the Community Safety Unit endorsed the project as a demonstration of ‘effective practice’.

i-Count HCV App developed by Tacola software Co-designed by nurses Data entered on – patient characteristics – test results – appointment dates – treatment – notes Data shared via secure NHS N3 network No data saved on tablets

Lessons Time needed to set up the project – Clinical and information governance – Bureaucracy takes time: you need to find the right person! – Clinical priorities Entering data into the app may require a bit of time to get used to The ideal solution would likely involve automatic demographics and results straight from routine systems.

Next steps Feasibility being evaluated by Prof William Rosenberg and Dr Ankur Srivastava, UCH Report in 2015

Viral Hepatitis Nurse-led Clinic In the last 2 years there have been over 230 patient episodes With a high DNA rate of 58% we started exploring ways to improve on attendance We found that working in partnership & implementing some small changes, that for the Islington referrals the DNA rate went down to 12.5%

Some of the Challenges and the Solutions The Challenge…. The Solution…. A secure account created so there is a central point for receipt of referral allowing them to be triaged and prompt appointment to be arranged Weekly clinic list sent to all referrers prior to clinic to facilitate appointment reminders Blood forms sent to BBV nurses to have bloods done locally at Drug Service Monthly clinical meeting set up to discuss patients progress and pending appointments Referral system needed to be stream-lined Managing high DNA rate Patients not attending for blood tests Patients DNA for investigations

“without Victoria's support and help with little things like reminding me of my appointments, ringing me up to check I am OK, and speaking to Naomi at the clinic I honestly don’t think I would have got to the hospital let alone on treatment. The communication between everyone has been brilliant and has kept me going through this really difficult time” Why it matters….

The LJWG 2014 conference is funded through educational grants from AbbVie Ltd, Gilead Sciences Ltd and MSD Ltd and sponsored by Bristol-Myers Squibb. None of the sponsors has had any control over the agenda or content.