<strong>Medicine</strong> with a Mission“It is incredibly important tous that the UND Center forFamily <strong>Medicine</strong> (CFM) isteaming up with us on thisresearch. There’s been noshortage of interest on thepart of residents and facultymembers at the CFM. It wastheir enthusiasm that allowedus to go forward...“From a public healthperspective, this study is ofgreat benefit to <strong>North</strong><strong>Dakota</strong>... and, it gets theresidents thinking.”John Hagan, M.D.<strong>North</strong> <strong>Dakota</strong> Department ofCorrections and RehabilitationClinical assistant professor ofinternal medicine, UND School of<strong>Medicine</strong> and Health SciencesIN THE STATES PRISONPOPULATION, we knew we had anissue, and we knew we had to dealwith it.The issue, said KathleenBachmeier (MSN 90), director ofmedical services at the <strong>North</strong> <strong>Dakota</strong>Penitentiary in Bismarck, is theexplosion in the number of inmateswho have contracted active hepatitis Cdue to drug use (mostlymethamphetamine) or infection fromtatooing with dirty needles.Research conducted by a team offour physicians and two nurses hasdemonstrated that an alternative, lesscostly drug regimen is effective fortreating prisoners with hepatitis C. Theteam includes Kent Martin, M.D.,clinical associate professor of familymedicine; Jeff Hostetter, M.D.(Bismarck Family <strong>Medicine</strong> Residency03), assistant professor of familymedicine and assistant program directorat the UND Center for Family<strong>Medicine</strong>-Bismarck; Olimpia Rauta,M.D. (Bismarck Family <strong>Medicine</strong>Residency 06); John Hagan, M.D.,clinical assistant professor of internalmedicine, with the <strong>North</strong> <strong>Dakota</strong> StatePrisons Division; Bachmeier, and BethTaghon, a nurse at the statepenitentiary, all of BismarckAt the Center for Disease ControlsNational Hepatitis C Conference lastyear, they presented a poster on theirpreliminary findings about the efficacyof a hepatitis C treatment that is givento prisoners in the states correctionalfacilities. They explained their initialsuccess in treating hepatitis C withconsensus interferon rather thanpeginterferon alpha-2b, the morecommon regimen.Spike in meth use reflected in prisonpopulationThe epidemic rise inmethamphetamine use in <strong>North</strong> <strong>Dakota</strong>has fueled a huge increase in thenumber of prisoners who have activehepatitis C in <strong>North</strong> <strong>Dakota</strong> prisons.The increasing prevalence of thedisease is striking, said Hagan, whoteaches UND medical students andresidents in Bismarck. Its been explosiveas the rate of IV meth use has grown.In order to address this publichealth emergency, the medical staff atthe states Department of Correctionsand Rehabilitation (DOCR) enlisted thehelp of Martin, infectious diseasespecialist with the Quain & RamstadClinic in Bismarck. Martin andHostetter, who have been working inthis area for several years, agreed totrack and write up the results.Initial treatment with peginterferonalpha-2b proved to be too costly tomaintain for the large number ofprisoners who require treatment, Martinsaid. In addition, the side effect rate inthe prison population was unacceptablyhigh, and treating these side effects iscostly. His research uncovered littleknowndata that showed consensusinterferon could be equally efficaciousand has a much lower side effect rate.The DOCR implemented thistreatment regimen and Hostetter, Haganand Rauta have tracked the results.Alternative treatment reduces costInitial data is very promising andpatients are tolerating the therapy muchbetter, according to Martin. Addedadvantages are: the cost of medicationsis 35 percent less and the need forsubspecialty referral has declined tonear zero.Using the standard regimen, thecost of treating a prisoner was $22,000per year; with the alternative treatment,that cost has been lowered to $14,000.The result has been an effectivetreatment regimen that is sustainablewithin the current medical budget ofthe DOCR.18 NORTH DAKOTA MEDICINE <strong>Fall</strong> <strong>2006</strong>
We were able toshow excellent treatmentresults, he said. Ourresults of success andtreatment are as good orbetter (than the traditionalregimen). We are able totreat many more peopleand bring more effectivetreatment to morepeople.Even if we haventchanged behaviors, theinmates weve treated --when theyre released --wont be able to infectanyone else, heemphasized.The group is pleasedthat initial findings havebeen well-received. Datacollection is ongoing andthere are plans to submitfinal results forpublication. Really a team effortIts a wonderfulpartnership, saidBachmeier, who championedthe project and requestedthe state legislature to fund it. Theprison couldnt have done it alone.This is really a team effort... Wevedone all this with no extra money. Itstarted from very, very humble, modestbeginnings.We work with people who reallywant to change their lives, she said.We want to be good stewards of thestates money; we select prisoners whoare compliant with the drug andalcohol treatment and are stableemotionally, based on psychiatricassessment. Prisoners must go throughsix months of close monitoring beforeever entering into treatment.In what might be described as asnowball effect, Martin and Hostetterwere invited to present their findings at ameeting of the American CorrectionsAssociation in August at Charlotte, NC.And the CDC has approached theresearchers about putting our programon their Web site as an outstandingBeth Taghon, a nurse at the state penitentiary, gives inmate Stuart Kelly an injection of consensusinterferon, an alternative treatment for hepatitis C.prisons hepatitis C model, Hostetter said.A resouce for the stateOne of the roles of physicians,residents and faculty in state-supportedacademic medical institutions is to be aresource for the state, Hostetter said.This is the perfect setting where theUND Department of Family andCommunity <strong>Medicine</strong> can assist anotherstate agency by utilizing our resourcesto enrich their programs.It is important for residentphysiciansto be involved in research inorder to teach them how progress inmedicine is truly made, he emphasized.Most significant medical advances canbe traced to community clinicians whohave made astute observations thatresearchers have only furtherelucidated.It is important for faculty to giveresidents the skills to function in thisarena of family medicine as well asday-to-day clinical practice.-Pamela D. KnudsonNORTH DAKOTA MEDICINE <strong>Fall</strong> <strong>2006</strong> 19