By: Camille Teape, Communications Coordinator, CAMH (Centre for Addiction and Mental Health)
Creating a lasting impact on the lives of people who visit health care spaces requires a devoted passion, an inquisitive curiosity and a spirit of advocacy. Across the health care network, professionals continue to push the envelope by developing new pathways to access, strengthening our purpose as we advocate for equitable care. Today, a CAMH hospitalist has recognized the disparaging gaps in the system for patients who live with acute mental illness and also carry a diagnosis of Hepatitis C.
Throughout her career, seasoned hospitalist, Dr. Renee Logan has provided medical care to inpatients who live with severe mental illness. To clients in acute care, forensic units, and the emergency department- Dr. Logan is intimately involved in the care process for her patients.
Photo caption: Dr. Renee Logan, CAMH hospitalist.
Coined as a clinical conundrum, Dr. Logan began to recognize a persistent pattern amongst her patients that live with diagnosis of hepatitis C — they weren’t being treated for it. Often, many patients didn’t have a primary care provider, which further increased the gap in care and treatment. “When I would ask my patients if they had ever been told about treatment or asked about treatment, they would tell me;
“Yeah, I know I have it - but my health provider says I have to stop drinking before they’ll treat me,” or, “My health provider says the medications are going to interfere with your mental illness, so we can’t really use them to treat your hepatitis C.”
Commonly transmitted through sharing needles and other drug equipment, hepatitis C can linger in the body for years and even decades without noticeable symptoms. Sharing drug equipment is not the only risk factor, for a multitude of reasons the prevalence of Hepatitis C, in those with SMI, is much higher than the general population and often goes unrecognized. Its effects can lead to serious complications such as cirrhosis, liver cancer and liver failure.
Fortunately, that changed with the introduction of direct-acting antivirals (DAAs), newly approved medications that revolutionized hepatitis C treatment. Unlike previous therapies, DAAs do not have the same psychiatric side effects and do not require patients to stop drinking to begin treatment — making them safe and accessible for individuals with mental illness.
Prescribed as oral medication over a two- to three-month period, DAAs can cure hepatitis C. Yet, the clinical conundrum remained: “I had a treatment that could help my patients, but the course lasted eight to twelve weeks, while many of the patients I cared for were in the hospital for only about two weeks. When I referred patients to the Toronto Center for Liver Disease, I was advised 75% to 95% of my patients were not showing up, significantly highlighting the barriers these patients experienced. How could I reconcile that? How could I get this treatment to people who needed it?”
By recognizing this care gap, Dr. Logan found a north star – bridging care by collaborating with other health care leaders across the organization.
This led her to connect Dr. Jordan Feld, a specialist who thoroughly examined the disparities patients living with mental illness and hepatitis C experience. Dr. Feld emphasized the importance of ensuring that hepatitis C treatment could be delivered within primary care — particularly during inpatient hospital stays. “He really wanted to empower primary care providers to do the treating because they see the majority of patients in Ontario and are perfectly able to provide this treatment.”
Another win, but another challenge quickly surfaced: lab testing often took more than a week to return results, by which time many patients had already been discharged. To address this, the team introduced point-of-care tests, which deliver results within the same hospital visit.
In introducing point-of-care tests, frontline staff can inquire with patients if they’ve considered hepatitis C testing. This innovation has become the focus of a randomized controlled trial on CAMH’s inpatient units, empowering hospitalists to discuss hepatitis C with patients and offer immediate testing. For many, this simple shift means faster answers, timely treatment, and new hope for recovery.
“If we can show that starting treatment with hospitalists is viable, feasible, and effective, we’d like to design a program where that becomes standard of care, with the goal to expand it hospital-wide.”
What began as a clinical conundrum has become a model of hope, proving that with collaboration, lasting change is possible – lifting sociatial health forward. Along with completing her Master’s in Public Health and learning the ukulele this fall, Dr. Logan intends to launch a Quality Improvement Fellowship that focuses on hepatitis C care for people living with mental illness.