Shared learning database

 
Organisation:
Spectrum Community Health CIC
Published date:
April 2013

This service development is aligned to the NICE Public Health Guidance Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection and more specifically Recommendation 2 in the document 'Awareness-raising for people at increased risk of hepatitis B or C infection'.

Following an analysis of testing and treatment uptake for hepatitis C by Spectrum Community Healthcare, it was found that the proportion of drug users in Wakefield accessing this provision was low. Patients cannot access treatment for hepatitis C locally; they are required to travel from Wakefield to Leeds. Whilst the distance between Wakefield and Leeds is only round 12 miles it was still viewed by drug users as a barrier to accessing hospital treatment. In order to address this and improve testing rates the wellbeing nursing team at Spectrum Community Health developed a hepatitis support service.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Yes
Does the example relate to a specific implementation of a specific piece of NICE guidance?
No

Example

Aims and objectives

To introduce a holistic hepatitis support service for drug users in Wakefield to increase access to testing and treatment for hepatitis C.

The aim of the hepatitis support service is to improve concordance and engagement with service users, offering education, testing and support. It aims to improve effective treatment outcomes for service users, liaising with St James' Hospital, Leeds to support the client to access a seamless care pathway.

Reasons for implementing your project

Prior to setting up the service, there was poor uptake in testing and vaccinations and referrals from the drug service for treatment at St James', Leeds were very low. Previously, referrals and testing were done at a monthly nurse-led clinic at the local drug service and this had a poor uptake. Since commissioned, the service has referred over 300 clients for assessment at St James' Leeds. Over 20 clients have completed treatment since 2007.

97 % of service users have been offered a hepatitis vaccination and 77% have received the vaccine (Ref: Green Report NDTMS).

How did you implement the project

A number of issues were looked at to identify gaps with regards to accessing hepatitis services and support. Clients expressed the following concerns:

- Actual fear about hepatitis due to lack of understanding and education.
- Anxiety around attending appointments; a lot of clients expressed bad experience with primary and secondary care and felt stigmatised by health services.
- Feeling unwell or experiencing physical symptoms of withdrawal prior to attending early morning appointments.
- Inability to access treatment in Leeds due to having to travel and a lack of support from services and family.
- The review identified that there were a high number of DNA's for both the testing clinics as well as the hospital assessment appointments for treatment.

The introduction of the hepatitis support service has enabled clients to access testing and vaccinations opportunistically, via drop-in and in conjunction with GPwSI prescribing clinics at the local drug service. The service has also recently initiated a drop- in Café club working in partnership with The Saviours Trust once a week. Service users from Turning point can attend this as well as homeless services users from the church to access testing and vaccinations health promotion and harm reduction.

In addition to clients being able to access testing and vaccinations opportunistically, a buddying service was also introduced to support and educate clients prior to referral to St James' for treatment as well as accompany them there for their hospital appointments. Not all clients require the buddying service but are supported by the wellbeing nurses in other areas such as liaising with their GP, taking venous bloods for patients who are difficult to bleed, prompting clients when their hospital appointments are due and offering ongoing support to motivate them to continue treatment. The service also liaises with the specialist nurses at St James' for example if they have difficulties obtaining venous bloods the wellbeing nurses will support in taking them. Any issues or concerns the wellbeing nurses will support and liaise with the clients GP and feedback to St James'. If a client disengages the nurses will do outreach and try to engage them and encourage them to attend hospital appointments again.

Key findings

- Evaluation of the effectiveness of the service has been achieved through collating data from SystmOne with regards to numbers tested and vaccinated, referrals to treatment and numbers commencing and finishing treatment. Figures discussed above.
- Service user feedback has also shown that the introduction of the service has alleviated their fears about accessing hepatitis services.
- Appointments, referrals and treatment outcomes have increased dramatically since Spectrums? wellbeing nurses implemented this service.
- New innovative ideas have been recognised by Nursing Standard and the service is awaiting an article to be published on innovative ways of working.

Key learning points

- Nurse time taking clients to appointments is costly but the aim of initially taking the client to the first two appointments to offer support has proved to be of benefit. It has become evident that following the provision of this support clients are more likely to continue treatment and attend future appointments by themselves working on a gradient exposure model.

- This model of working requires an imaginative approach to a system of working which is service user led. Service user feedback is vital in evaluating the effectiveness of the system, informing future plans and developments. The health screening assessment tool which is used by the nurses provides a vehicle to promote education and testing in the first instance.

Contact details

Name:
Sheila Hayward
Job:
Wellbeing Nurse
Organisation:
Spectrum Community Health CIC
Email:
Sheila.hayward@spectrum-cic.nhs.uk

Sector:
Is the example industry-sponsored in any way?
No