title: Evaluation of the regional nurse-supported hepatitis C shared care program in Western Australia: a mixed methods study.
abstract: BACKGROUND
  Nurse-supported shared care services for patients living with hepatitis C have been implemented in some regional areas of Western Australia to provide access to local treatment and care services for patients and to improve currently low levels of treatment uptake. This study collected data from health professionals involved in managing the care of patients living with hepatitis C and from patients engaged in regional nurse-supported hepatitis C shared care services in Western Australia.
  
  
  METHODS
  Key informant qualitative interviews were conducted with health professionals in regions operating a nurse-supported shared care service and in regions without this service. Patients engaged in the shared care program at the time of the study were invited to complete a short questionnaire.
  
  
  RESULTS
  Nurse-supported shared care services reduced patient transport costs to tertiary centres, accelerated access to treatment and delivered >98% compliance with treatment schedules. Patients engaged with regional hepatitis C shared care services expressed high levels of satisfaction and indicated that they would delay treatment if it was not available locally. Telehealth support from tertiary liver clinics and allied health services were available to health professionals engaged in regional shared care services and were used effectively. There was limited participation by general practitioners in regional hepatitis C shared care services and regional patients' access to treatment was influenced by the availability and capacity of health professionals. Uptake of treatment and engagement in the regional shared care program was limited for Aboriginal people and younger people although these groups had the highest rates of hepatitis C notifications in Western Australia.
  
  
  CONCLUSIONS
  The patients consulted for this study preferred to access hepatitis C treatment and care locally rather than travel to tertiary liver clinics, up to 1500 kilometres away. The reasons for limited engagement in the shared care program by some groups with high rates of hepatitis C notifications requires further investigation. Health professionals identified several benefits of the shared care program including continuity of care for patients, shorter waiting times, longer appointment times and high levels of treatment compliance.
  
  
  CONCLUSIONS
  Hepatitis nurses in regional areas can coordinate effective patient treatment and care when supported by treatment protocols and access to physicians and liver specialists, including through telehealth. Treatment and care options to suit individual preferences are required to avoid further stigmatising marginalised groups. The role of primary care in facilitating hepatitis C treatment uptake should be explored further including strategies for improving the participation of general practitioners in regional shared care services.
authors.affiliation: Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Bentley, WA, 6845, Western Australia. roanna.lobo@curtin.edu.au.
authors.forename: Roanna
authors.initials: R
authors.lastname: Lobo
authors.affiliation: Formerly Sexual Health and Blood-borne Virus Program, Communicable Disease Control Directorate, Western Australian Department of Health, Perth, Western Australia. lester.mascarenhas@isispc.com.au.
authors.forename: Lester
authors.initials: L
authors.lastname: Mascarenhas
authors.affiliation: Sexual Health and Blood-borne Virus Program, Communicable Disease Control Directorate, Western Australian Department of Health, Perth, Western Australia. david.worthington@health.wa.gov.au.
authors.forename: David
authors.initials: D
authors.lastname: Worthington
authors.affiliation: Sexual Health and Blood-borne Virus Program, Communicable Disease Control Directorate, Western Australian Department of Health, Perth, Western Australia. judith.bevan@health.wa.gov.au.
authors.forename: Judith
authors.initials: J
authors.lastname: Bevan
authors.affiliation: Sexual Health and Blood-borne Virus Program, Communicable Disease Control Directorate, Western Australian Department of Health, Perth, Western Australia. donna.mak@health.wa.gov.au.|School of Medicine, University of Notre Dame, Fremantle, Western Australia. donna.mak@health.wa.gov.au.
authors.forename: Donna B
authors.initials: DB
authors.lastname: Mak
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D005260:Female; D058005:General Practitioners; D006296:Health Services; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000451:nursing*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D015397:Program Evaluation; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014904:Western Australia