Implementation of a multidisciplinary, team-based model to treat chronic hepatitis C in the primary care setting: Lessons learned.

Hepatitis C virus (HCV) is the most common blood-borne virus in the U.S., and its incidence continues to rise. With approval of direct-acting antiviral medications, treatment for Chronic Hepatitis C (CHC) has become highly efficacious with a minimal side effect profile. Primary care physicians are well-positioned to address this increased demand, yet most do not feel comfortable treating CHC. In this case report, we describe implementation of a multidisciplinary team-based approach for treating CHC at multiple primary care sites across a large safety net health system. We focus on the evolving nature of implementation of our model through iterative Plan-Do-Study-Act (PDSA) cycles, highlighting the importance of developing an interdependent, multidisciplinary team, providing training, and ongoing support of Primary Care Hepatitis C Specialists, responding to the evolving nature of CHC treatment and policies, and ensuring high quality treatment. This process allowed us to continually grow and adapt our approach to make it feasible and successful. We share our "lessons" learned for others looking to bring CHC treatment, and potentially other specialty-based treatment, into the primary care setting.