September 20, 2019

Submitted via: uspreventiveservicestaskforce.org

To Whom It May Concern,

On behalf of the National-Nurse Led Care Consortium (NNCC), I thank you for the opportunity to comment on the proposed Recommendation Statement regarding “Hepatitis C Virus Infection in Adults and Adolescents: Screening.” As an organization, NNCC supports nurse-led care, and advocates for nurse leaders across sectors. As a part of this mission, we provide public health programming to health centers to improve testing, linkage to care, and treatment for hepatitis C virus (HCV).

Comments:

I. Additional evidence and viewpoints: NNCC believes that the recommendation should include evidence that patients in active substance use have similar treatment completion rates and sustained virological response (SVR) to those who do not use substances. Several studies have found no statistical difference in treatment outcomes for patients who remained abstinent from drugs and those who either relapse or do not have co-occurring substance use disorders.

II. Clarifying the draft Recommendation Statement: NNCC recommends several ways to make the draft Recommendation Statement clearer, including:

a. Designating best practices for testing: NNCC recommends that health care providers use the HCV antibody test that automatically reflexes to test the PCR RNA as a best practice. This test uses one blood draw rather than two and requires only one appointment for patients, which avoids delay in confirming diagnoses for positive patients.

b. Denoting Screening Intervals: NNCC recommends that high-risk patients are tested every three to six months, specifically those in active injection drug use and/or those with HIV or HBV co-infection.

c. Expanding on Screening Implementation: NNCC recommends that health care staff and providers use opt-out screening language rather than voluntary testing opt-in language to increase the likelihood of patients accepting the HCV test.

d. Treatment: Although treatment is not recommended for pregnant women who are HCV positive, there should be guidance on monitoring the mother and child after birth to avoid chronic infection for the mother and discuss treatment options for the child, if HCV is transmitted during labor.

e. Update to Previous USPSTF Recommendation: NNCC suggests that the recommendation include that initiating treatment at earlier stages of disease will avoid high medical costs for complications from chronic HCV, such as liver disease, as well as fewer deaths from long term disease.

III. Excluded information: While the Draft Recommendation Statement will increase the number of people screened for HCV, it does not discuss the Medicaid treatment restrictions that pose barriers for patients to access treatment. Higher screening rates will lead to increased diagnoses of HCV, which will require increased access to treatment. Several states’ Medicaid programs still have treatment restrictions before patients can be approved for medication:

a. Fibrosis Score Restriction: Pennsylvania has eliminated Fibrosis Score restrictions for Medicaid beneficiaries that prevented diagnosed patients from receiving appropriate care. This prevented patients from accessing affordable medication to treat the disease at earlier stages, which would avoid complications and long-term health consequences.

b. Sobriety Restriction: Pennsylvania has eliminated sobriety restrictions because of aforementioned research that shows patients in active substance use can complete treatment at the same rates as those without mental health or substance use disorders. Research also shows that substance use does not interfere with success of HCV treatment. Sobriety restrictions are stigmatizing to patients with diagnosed behavioral health and substance use disorders, and prevent those patients from accessing treatment the way other patients with HCV do.

c. Provider Restriction: Due to the success of different medications that treat HCV, it is not required that a specialist, such as an infectious disease physician or hepatologist, treat patients with HCV. Primary Care Providers can gain capacity and knowledge through accessible trainings and consultation with specialists to treat their patients with HCV and successfully guide them through treatment. NNCC advocates for the USPSTF to recommend the elimination of provider restrictions nationally.

IV. Resources and Tools: NNCC requests that the USPSTF provide resources for health settings to locate increased financial support for screening tests, required labs, and treatment for under- and uninsured patients. V. Our Experience: Benefits of Early Detection or Treatment:

a. Public Health Management Corporation (PHMC) Health Centers in Philadelphia, PA started routine HCV screening for patients 18 and older in 2013. Since implementation, the PHMC health centers have more than doubled the number of patients screened, and due to increased screening, the rate of positive cases went from 4.5% to 5.3%. Therefore, PHMC health centers have seen 52.8% more patients who have completed treatment.

NNCC appreciates the opportunity to comment on this draft recommendation statement.

Sincerely,

Sarah Hexem Hubbard, Esq.
Executive Director
National Nurse-Led Care Consortium

Click here to download our comments.

The Pennsylvania Action Coalition is excited to announce “At the Core of Care,” a new podcast series that highlights the creative efforts of nurses and their partners to meet the health and health care needs of patients, families, and communities. “At the Core of Care” weaves together themes of diversity, leadership, and practice innovation in nursing, while staying focused on the consumer experience.

Through four episodes, those at the core of care tell the stories of different health care situations, including sexual assault nurse examiners; breastfeeding clients from the Philadelphia Nurse-Family partnership; nurses as they attempt to ease state restrictions on the profession; and those involved in home care for medically complex children.

The stories are based in Pennsylvania but tell a much bigger story about important trends shaping health and health care across America.

It was an amazing experience to sit down and speak with so many incredible people about the work they do and how nursing impacts their lives. Here’s a preview of what to expect in the first season:

Episode 1: Sexual Assault Nurse Examiners

This episode takes a look at sexual assault nurse examiners in Pennsylvania. Few healthcare providers are trained to do this work, which requires a timely and skilled healthcare response that addresses physical and mental health. Examiners must also be trained on the forensic and legal component so they can collect evidence that can hold up in court. An innovative program out of Penn State University, the SAFE-T Center closes a gap in services offering telehealth support for medical practices in rural and underserved areas.

Episode 2: Breastfeeding Support at the Philadelphia Nurse-Family Partnership

The Philadelphia Nurse-Family Partnership is an evidence-based home visiting program that serves new mothers and families. They offer support for new mothers who are struggling with breastfeeding. In this episode we hear from nurses and the moms who were in this program about their challenges, and how their nurse helped them.

Episode 3: The Fight for Full Practice Authority in Pennsylvania

Nurse practitioners are educated and trained to provide primary care services, but state law creates barriers for them to care for patients. Pennsylvania has some of the best nursing schools in the country. Why doesn't the state allow graduates to practice to the full extent of their education? Nurse practitioners across Pennsylvania have fought for years to modernize the state's nursing law. In this episode, we speak to nurses as they gather in Harrisburg to meet with lawmakers and advocate for themselves and their patients at the Pennsylvania Coalition of Nurse Practitioners’ Lobby Day.

Episode 4: Pediatric Home Care for Medically Complex Children

This episode focuses on the unique challenges of pediatric home care for medically complex children. Retaining nurses in this complex field can be difficult. This episode takes us to Lancaster County, Pennsylvania, and features one of the most interesting interviews of the series with a nurse who was inspired to pursue pediatric care because she is also the mother of a child who needs 24-hour care. She works tirelessly as a nurse, mother, and advocate for families like her own through the Technology Assisted Children’s Home Program.

Listen to a Preview

The At the Core of Care podcast series is an initiative of the Pennsylvania Action Coalition. Funding is provided by AARP and the Robert Wood Johnson Foundation as part of the Future of Nursing: Campaign for Action Innovations Fund. The Pennsylvania Action Coalition is partnering with Kouvenda Media, a social change multimedia production company, to facilitate all interviews with project partners who will be featured in the podcast series. The Pennsylvania Action Coalition is housed in the National Nurse-Led Care Consortium, a subsidiary of the Public Health Management Corporation (PHMC).

Please subscribe today on your favorite podcast app and listen to the full first season today.

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The National Nurse-Led Care Consortium is a member of the Nursing Community Coalition.

September 5, 2019

Dear Chairman Alexander and Ranking Member Murray,

On behalf of all 62 Nursing Community Coalition (NCC) member organizations we respectfully urge the Senate Health, Education, Labor, and Pensions Committee to consider and advance Title VIII Nursing Workforce Reauthorization Act of 2019 (S.1399) this year. S. 1399 is a bipartisan bill that would reauthorize the Nursing Workforce Development Programs (authorized under Title VIII of the Public Health Service Act [42 U.S.C. 296 et. seq]), through Fiscal Year 2024. As the cross section of education, practice, research, and regulation, the NCC recognizes the immense value these programs have on nursing students, the nursing profession, patients, and communities across the country. That is why passing S.1399, Title VIII Nursing Workforce Reauthorization, is the NCC’s number one priority.

Title VIII Nursing Workforce Development Programs bolster nursing education at all levels, support institutions that educate future nurses, recruit and retain the nursing workforce, and are essential to ensuring the demand for nursing care is met, especially in rural and underserved areas. These programs are crucial to ensuring that we are able to connect patients with high-quality care across a variety of settings including in community health centers, hospitals, long-term care facilities, local and state health departments, schools, workplaces, and patients’ homes. S. 1399, reinforces the lasting impact Title VIII programs have, while making slight modifications that reflect the current health care needs of our nation.

The NCC appreciates the Committee’s continued commitment to the nursing profession and encourages the swift consideration and advancement of S.1399- Title VIII Nursing Workforce Reauthorization Act of 2019. The NCC looks forward to working with the Committee on this essential issue and if we can be of any assistance to you or your staff, please do not hesitate to contact the coalition’s Executive Director, Rachel Stevenson, at or 202-463-6930, ext. 271.

Sincerely,

The Nursing Community Coalition

Click here to download the letter.

National Nurse-Led Care Consortium (NNCC), a PHMC subsidiary, has partnered with Children’s Hospital of Philadelphia (CHOP) to design and implement an integrated nursing staffing model at CHOP’s Cobbs Creek primary care site. Funded by Vanguard’s Strong Start for Kids Program™, the project will integrate home visiting nurses into the pediatric primary care setting and aims to improve the health and well-being of mothers and their young children.

"Families served by nurse home visitors are often facing complex social issues and require enhanced services beyond the scope of what evidence-based home visiting models can typically independently provide," said Sarah Hexem Hubbard, Esq, executive director of NNCC. "We are excited to embark on this visionary journey to intentionally integrate our services with CHOP Primary Care in order to address the health and well-being of families, and see this integration as critical to achieving overall impact and outcomes for our communities."

CHOP’s PolicyLab will work closely with NNCC to improve efficiencies, reduce burden across providers and, ultimately, improve patient care. Researchers at PolicyLab will also evaluate the new model of care to see if it improves child health outcomes, reduces trips to the emergency room, increases parental awareness of quality child care options, and improves staff satisfaction and retention.