Hepatitis C elimination: amplifying the role of primary care nurses in Australia
Jacqueline A. Richmond A B * , Melinda Hassall C and Jack Wallace A D EA
B
C
D
E
Abstract
Australia’s commitment to eliminate hepatitis C by 2030 is underpinned by the mobilisation of the primary care sector. Primary care nurses are well placed to contribute to achieving elimination given their unique access to people with/at risk of hepatitis C and their person-centred approach to care delivery. This study examines the enablers to primary care nurse involvement in elimination efforts.
Primary care nurses involved in the care of people with/at risk of hepatitis C were recruited through two national nursing organisations. Participants provided verbal consent to participate in an electronically recorded, semi-structured interview. Interview data were transcribed verbatim, coded and analysed using a thematic analysis.
Sixteen interviews were conducted with nurses working in general practice, community health, alcohol and other drug services, and custodial settings, with the findings framed using a social-ecological model. The study identified individual attributes, such as empathy and advocacy for clients deemed ‘too hard for everyone else’. Interpersonal enablers included participants’ ability to effectively communicate with clients and colleagues, and using trusted professional relationships to improve client access to care. Public policy that addressed community factors, including stigma and confidentiality, were seen as supportive.
This study identified the critical and varied role primary care nurses play in hepatitis C elimination. Effective scale up of hepatitis C care involves recognising the pivotal role of primary care nurses, which will help to create an enabling environment that supports nurses to work to their full scope of practice and enhance their contribution to the elimination response.
Keywords: Australia, enablers, hepatitis C elimination, nurse, qualitative primary care, scope of practice, socio-ecological model.
References
Angeles MR, Crosland P, Hensher M (2023) Challenges for Medicare and universal health care in Australia since 2000. Medical Journal of Australia 218(7), 322-329.
| Crossref | Google Scholar | PubMed |
Australia and New Zealand Council of Chief Nursing and Midwifery Officers and Nursing and Midwifery Board of Australia (2017) Registered nurse and midwife prescribing – Discussion paper. Nursing and Midwifery Board, Canberra, ACT, Australia. Available at https://www.ahpra.gov.au/Search.aspx?q=Registered%20nurse%20and%20midwife%20prescribing%20discussion%20paper [Verified 25 September 2023]
Australian College of Nursing (2019) Person-centred care. Australian College of Nursing, Canberra, Australia. Available at https://www.acn.edu.au/wp-content/uploads/position-statement-person-centred-care.pdf [Verified 25 September 2023]
Australian Government Department of Health (2018) Fifth National Hepatitis C Strategy 2018–2022. Australian Government Department of Health, Canberra, ACT, Australia. Available at https://www.health.gov.au/sites/default/files/documents/2022/06/fifth-national-hepatitis-c-strategy-2018-2022.pdf [Verified 25 September 2023]
Australian Institute of Health and Welfare (2023) Primary health care. Australian Institute of Health and Welfare, Canberra, ACT, Australia. Available at https://www.aihw.gov.au/reports-data/health-welfare-services/primary-health-care/overview [Verified 25 September 2023]
Biondi MJ, Feld JJ (2020) Hepatitis C models of care: approaches to elimination. Canadian Liver Journal 3(2), 165-176.
| Crossref | Google Scholar | PubMed |
Bodenheimer T, Bauer L (2016) Rethinking the primary care workforce – an expanded role for nurses. New England Journal of Medicine 375, 1015-1017.
| Crossref | Google Scholar | PubMed |
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77-101.
| Crossref | Google Scholar |
Burnet Institute and Kirby Institute (2022) Australia’s progress towards hepatitis C elimination: annual report 2022. Burnet Institute, Melbourne, Vic, Australia. Available at https://www.burnet.edu.au/media/1trbt5iy/australias-progress-towards-hepatitis-c-elimination-annual-report-2022-anna-wilkinson.pdf [Verified 25 September 2023]
Byrne CJ, Radley A, Inglis SK, Beer L, Palmer N, Duc Pham M, Allardice K, Wang H, Robinson E, Hermansson M, Semizarov D, Healy B, Doyle JS, Dillon JF (2022) Reaching people receiving opioid agonist therapy at community pharmacies with hepatitis C virus: an international randomised controlled trial. Alimentary Pharmacology & Therapeutics 55(12), 1512-1523.
| Crossref | Google Scholar | PubMed |
Gilliver R, Silins E, Read P (2022) ‘Lifting the invisibility cloak’ on the pivotal role of nurses in hepatitis C (HCV) testing, diagnosis and management – findings from an integrated primary healthcare service for marginalised people in inner Sydney, Australia. Australian Journal of Advanced Nursing 39(4), 43-47.
| Crossref | Google Scholar |
Harney BL, Whitton B, Paige E, Brereton R, Weiss R, Membrey D, Wade AJ, Iser D, Kemp W, Roberts SK, Spelman T, Sacks-Davis R, Hellard ME, Doyle JS (2022) A multi-site, nurse-coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia. Liver International 42(3), 522-531.
| Crossref | Google Scholar | PubMed |
Hepatitis C Virus Infection Consensus Statement Working Group (2022) Australian recommendations for the management of hepatitis C virus infection: a consensus statement. Gastroenterological Society of Australia, Melbourne, Vic, Australia. Available at https://hepcguidelines.org.au [Verified 25 September 2023]
Kwon JA, Dore GJ, Hajarizadeh B, Alavi M, Valerio H, Grebely J, Guy R, Gray RT (2021) Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications. PLoS ONE 16(9), e0257369.
| Crossref | Google Scholar |
McLaren L, Hawe P (2005) Ecological perspectives in health research. Journal of Epidemiology & Community Health 59, 6-14.
| Crossref | Google Scholar | PubMed |
Medsafe – New Zealand Medicines and Medical Devices Safety Authority (2022) Application to increase access to Maviret through exemption to prescription status for specific nurses. Medsafe, Wellington, New Zealand. Available at https://www.medsafe.govt.nz/profs/class/Agendas/Agen69/6.1bMaviret.pdf [Verified 25 September 2023]
Nursing and Midwifery Board of Australia (NMBA) (2016) Registered nurse standards for practice. Nursing and Midwifery Board, Canberra, ACT, Australia. Available at https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx [Verified 25 September 2023]
NMBA (2023) Consultation regulation impact statement: registration standard: endorsement for scheduled medicines – designated registered nurse prescriber. Nursing and Midwifery Board, Canberra, ACT, Australia. Available at https://www.nursingmidwiferyboard.gov.au/News/Past-Consultations.aspx [Verified 25 September 2023]
Papaluca T, McDonald L, Craigie A, Gibson A, Desmond P, Wong D, Winter R, Scott N, Howell J, Doyle J, Pedrana A, Lloyd A, Stoove M, Hellard M, Iser D, Thompson A (2019) Outcomes of treatment for hepatitis C in prisoners using a nurse-led, statewide model of care. Journal of Hepatology 70(5), 839-846.
| Crossref | Google Scholar | PubMed |
Radley A, de Bruin M, Inglis SK, Donnan PT, Hapca A, Barclay ST, Fraser A, Dillon JF (2020) Clinical effectiveness of pharmacist-led versus conventionally delivered antiviral treatment for hepatitis C virus in patients receiving opioid substitution therapy: a pragmatic, cluster-randomised trial. The Lancet Gastroenterology & Hepatology 5(9), 809-818.
| Crossref | Google Scholar | PubMed |
Randall S, Crawford T, Currie J, River J, Betihavas V (2017) Impact of community based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: a systematic review. International Journal of Nursing Studies 73, 24-33.
| Crossref | Google Scholar | PubMed |
Rashidi A, Higgs P, Carruthers S (2020) Aboriginal people with chronic HCV: the role of community health nurses for improving health-related quality of life. Collegian 27(3), 250-257.
| Crossref | Google Scholar |
Richmond J, Wheeler E, Warner S, Mason S (2014) Developing the Australasian Hepatology Association’s consensus-based guidelines for the nursing care of patients with liver disease. Contemporary Nurse 48(1), 36-45.
| Crossref | Google Scholar | PubMed |
Richmond JA, Gallagher L, McDonald L, O’Sullivan M, Fitzsimmons C, Pedrana A (2020) Achieving hepatitis C elimination by using person-centered, nurse-led models of care: a discussion of four international case studies. Gastroenterology Nursing 43(4), 303-309.
| Crossref | Google Scholar | PubMed |
Scott N, Sacks-Davis R, Wade AJ, Stoove M, Pedrana A, Doyle JS, Thompson AJ, Wilson DP, Hellard ME (2020) Australia needs to increase testing to achieve hepatitis C elimination. Medical Journal of Australia 212, 365-370.
| Crossref | Google Scholar | PubMed |
Seear K, Lenton E (2021) Becoming posthuman: hepatitis C, the race to elimination and the politics of remaking the subject. Health Sociology Review 30(3), 229-243.
| Crossref | Google Scholar | PubMed |
Selfridge M, Barnett T, Lundgren K, Guarasci K, Milne R, Drost A, Fraser C (2022) Treating people where they are: nurse-led micro-elimination of hepatitis C in supported housing sites for networks of people who inject drugs in Victoria, Canada. Public Health Nursing 39(5), 1009-1016.
| Crossref | Google Scholar | PubMed |
The Polaris Observatory HCV Collaborators (2022) Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. The Lancet Gastroenterology & Hepatology 7(5), 396-415.
| Crossref | Google Scholar |
Treloar C, Rance J, Hopwood M (2016) “Hepatitis C treatment and the new patient”: a qualitative study of general practitioners’ views on the provision of hepatitis C treatment in general practice. Australian Journal of Primary Health 22(6), 561-566.
| Google Scholar |
Wade AJ, Doyle JS, Gane E, Stedman C, Draper B, Iser D, Roberts SK, Kemp W, Petrie D, Scott N, Higgs P, Agius PA, Roney J, Stothers L, Thompson AJ, Hellard ME (2020) Outcomes of treatment for hepatitis C in primary care, compared to hospital-based care: a randomized, controlled trial in people who inject drugs. Clinical Infectious Diseases 70(9), 1900-1906.
| Crossref | Google Scholar | PubMed |
Wallace J, Richmond J, Allard N, Howell J, Adamson E, Xiao Y, O’Reilly C, Hellard M (2020) Facilitating hepatitis B clinical management in general practice: a qualitative investigation. Australian Journal of General Practice 49(9), 599-604.
| Crossref | Google Scholar | PubMed |
WHO (2018) Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection. World Health Organization, Geneva, Switzerland. Available at https://www.who.int/publications/i/item/9789241550345 [Verified 25 September 2023]
WHO (2022) Global Health Sector Strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030. World Health Organization, Geneva, Switzerland. Available at https://iris.who.int/bitstream/handle/10665/360348/9789240053779-eng.pdf?sequence=1 [Verified 7 June 2024]
