The role of Nurse Practitioners (NP) within our healthcare system is significant and unique and they are well recognised as expert providers of comprehensive health care. NPs around Australia are now eligible to prescribe s100 medicines for the treatment of HIV, hepatitis B and hepatitis C and some have already started integrating s100 prescribing in to their routine patient care.
Two NPs from NSW have already been approved by the Hepatitis B Clinical Standard and Advisory Panel as accredited prescribers, determined by their grounding and experience in practice of hepatitis B medicine. An additional 4 NPs in Victoria have completed the online Hepatitis B s100 prescriber course and have pending applications for accreditation and 8 NPs from NSW and Qld are currently enrolled in the online course. Seven NPs from Qld, Victoria and the ACT have successfully completed the online HIV s100 prescriber course, with 5 NPs already achieving accreditation.
Read about the experiences of NPs Tracey Jones, Dale Thompson, Sinead Sheils and Chris Wallis and the impact of prescribing medicines for HIV, hepatitis B and hepatitis C on their practice and patients.
Tracey Jones – Hepatology NP, Justice Health and Forensic Mental Health Network, NSW
Where are you currently working?
I am currently employed by the Justice Health and Forensic Mental Health Network (JHFMHN), Population Health Directorate. I am the first endorsed Hepatology NP to work within Justice Health having commenced the role in June 2019.
I have been an endorsed NP since March 2007 and have been prescribing medications relevant to my scope of practice for many years including hepatitis C medications. Whilst as an NP, I have been eligible to prescribe hepatitis C medications since 2018, within the correctional settings in Australia, hepatitis C medications were dispensed via the s100 legislation.
Since the PBS change on 1st April, I have commenced as an additional prescriber within the JHFMHN, prescribing hepatitis C medications for patients via the s100 program. In regard to hepatitis B, prior to commencing in the correctional system I had limited previous experience providing management and care to hepatitis B patients.
Why is it important for you to be able to prescribe s100 medicines?
I have commenced the ASHM HBV Online Prescriber Course to address my knowledge deficits as it is vitally important that I upskill within this area. Hepatitis B prevalence with the NSW correctional settings is significant and it is important that I can provide appropriate, informed management and care to these patients.
The greatest benefit of being able to prescribe s100 medications is the ability to work to the fullest capacity of my scope of practice with all components available to me including prescribing medications relevant to patient care.
Integrating s100 prescribing in to care
By having the ability to prescribe s100 medications as an NP it enables me to provide holistic care and management to my patients including treatment options. Discussions and decisions relevant to treatment options can occur as part of patient management, with potential treatment commencement evolving from those discussion/decisions.
International recognition for Tracey
Tracey was recently awarded the Associate Fellow – American Association for the Study of Liver Diseases (AASLD) designation, the first Australian nurse to receive this Fellowship. The award recognises clinical excellence and significant contribution to the field of liver disease and further reinforces Tracey’s position as a leader within the field of hepatology and a significant resource for her many colleagues.
Tracey was the first hepatology NP in NSW, the founding member and inaugural President of the Australasian Hepatology Association and a strong early advocate for NP prescribing of treatment for hepatitis B and C.
Dale Thompson – NP, Mt Isa Sexual Health, QLD
Where are you currently working?
I joined Mount Isa Sexual Health in 2019 and shortly thereafter completed my NP training. I moved to the North West Hospital and Health Service (NWHHS) from a similar position in rural Victoria and joined a health service that includes several innovative NP models of care. As a NP with Mt Isa Sexual Health, I am fortunate to work clinically with people who are not only living with HIV, however thriving and getting on with their lives.
Why is it important for you to be able to prescribe s100 medicines?
Completing the ASHM HIV prescriber authorisation training program has enabled me to prescribe HIV medications. I have great support from an experienced HIV prescriber from the Townsville Health Service who visits regularly and is available on the phone. Being able to prescribe HIV medications strengthens the clinical model of care within the NWHHS and ensures people are able to receive the care they need from local clinicians close to the community they live. This reduces fragmentation and barriers to care and improves the capacity of the nursing workforce within the NWHHS.
Integrating s100 prescribing in to care
As a NP I can prescribe hepatitis C anti-viral therapy, PrEP, PEP and I am part way through the hepatitis B prescriber course and will soon be authorised to prescribe hepatitis B s100 medicines. The HIV prescriber course enables me to prescribe s100 medicines in a community that includes a large cohort of Aboriginal and Torres Strait Islanders and people who were born in high prevalence countries, including South East Asia and Africa. We are remote and distances are vast and NWHHS has embraced the NP model of care, which enables specialist nurses to make a contribution that is equal to the skills they have acquired through clinical practice and post graduate university training. Working in rural and remote settings, in particular with Mount Isa Sexual Health is a great experience.
Sinead Sheils – NP, Royal Prince Alfred Hospital, Sydney, NSW
Where are you currently working?
My Hepatology NP role is based at RPA Hospital, Camperdown, but based in a range of community settings around Sydney’s Inner West, delivering viral hepatitis and cirrhosis focused care. I work with priority populations including people who inject drugs, people in or recently in custodial settings, Aboriginal people and people from culturally and linguistically diverse backgrounds. I work alongside drug health, mental health, Aboriginal health, homelessness health, primary health and NGO partners, building capacity around viral hepatitis care, identifying barriers to care and delivering complete care within a ‘one stop shop’ model. I completed the ASHM face to face training in 2019, prior to NPs being approved for s100 prescribing, as part of routine NP Continuous Professional Development and in readiness for likely PBS approval during 2020.
Why is it important for you to be able to prescribe s100 medicines?
Being authorised to prescribe s100 hepatitis B treatments adds to my NP Scope of Practice. The strength of the NP role is the ability to offer complete care to a patient in the setting where they are being seen. Previously, episodes of care could be fractured or care delivery delayed as a result of NPs not being authorised to prescribe treatment when indicated. The patient may have been required to attend another service for a medical consultation with unnecessary additional delays and added costs in money or time. This process could also undermine the therapeutic relationship that the NP had established with the patient.
What are the greatest benefits to you being able to prescribe s100 medicines?
Now, when I see a person with hepatitis B, I can conduct that consultation with the knowledge and authority which includes s100 treatment prescribing if it is indicated. The ASHM course and ongoing prescriber updates are useful to keep knowledge refreshed and current. As a novice s100 hepatitis B prescriber, I have close linkage with my RPAH liver colleagues for specialist clinical support if sought.
Chris Wallis – NP, Prison Health Services, Brisbane, QLD
Where are you currently working?
My current NP role is overseeing hepatitis C (HCV) treatments across 5 adult prisons in South East Queensland, with a population of approximately 3700 prisoners. I run clinics at a different prison each day, managing HCV cases from diagnosis through to treatment initiation and referrals to Hepatology at Princess Alexandra Hospital for those with advanced liver disease. Our service also provides a mobile Fibroscan and telehealth consults with tertiary specialists to reduce the number of prisoners requiring hospital transports.
Why is it important for you to be able to prescribe s100 medicines?
Changes to the s100 HCV Antiviral prescribing regulations from April 1st 2020, resulted in NP’s working autonomously when managing and treating patients with HCV in the prison setting being able to close the circle of care and prescribe HCV medications, without needing the involvement of a Medical Officer. Prior to this change, a Medical Officer would need to write and authorise HCV antiviral scripts for patients they had never seen.
Having worked in this specialty since early 2018, I became an accredited HCV S100 prescriber through my previous experience in the management of HCV. It was a natural progression to take the final step and prescribe the medications that I had recommended to my patients and not have that responsibility be a burden on another clinician.
What are the greatest benefits to you being able to prescribe s100 medicines?
The biggest benefit to NP S100 prescribing in the management of HCV is improvement in “time to treatment”. Previously it was 1-2 weeks after treatment approval before scripts would be generated by the Medical Officer, then a further 1-2 weeks waiting for medication to be ordered and dispensed by our hospital pharmacy. With NP’s prescribing HCV antivirals and collaborative work with pharmacy/drug companies, we can now commence treatment in the prison setting within 7-10 days of the patient consult. This change has resulted in a sharp increase in the number of prisoners receiving HCV treatments in South East QLD, and with the advent of Point-Of-Care testing technology, this number should continue to climb, further adding to the crucial work of HCV elimination in Australia.
