Telemedicine Specialty Support Promotes Hepatitis C Treatment by Primary Care Providers in the Department of Veterans Affairs

Purpose: Hepatitis C incidence is higher among American Indian/Alaskan Native populations than any other racial or ethnic group in the United States. Chronic Hepatitis C complications include cirrhosis of the liver, end stage liver disease, and hepatocellular cancer. Direct acting antiviral treatment taken orally results in > 90% cure, yet rural primary care providers lack the training and confidence to treat and monitor patients with chronic Hepatitis C. Rural patients are reluctant to travel to urban areas for Hepatitis C treatment. Project ECHO is an innovative tele-mentoring program where specialists mentor primary care providers via videoconferencing to treat diseases they would otherwise be unable to manage. The purpose of this quality improvement project was to increase Hepatitis C treatment at a rural Navajo health clinic through partnership with Project ECHO specialists. Methods: This quality improvement project was guided by Lippitt’s Phases of Change Theory. The systematic process plan included a protocol for roles and expectations of all members of the healthcare team, a documentation and communication plan, and a tracking system for monitoring patient progress through the plan of care. Outcomes were analyzed by descriptive statistics. Findings: Following partnership with Project ECHO, six patients (31.6%) consented to receiving Hepatitis C treatment at the rural Navajo health clinic. All six were contacted by outreach staff at multiple points during the project. Five (26.3%) completed the full course of drug therapy. Four (21.1%) completed follow-up lab work, of which three (15.8%) had a documented cure by sustained virologic response. Conclusions: Hepatitis C care via Project ECHO-rural clinic partnership was affordable, feasible and not excessively time consuming for a facility with substantial patient outreach resources. Key words: Rural health clinic, Hepatitis C, Project ECHO, tele-mentoring, Native American

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P60 Supporting hepatitis C treatment uptake by primary care providers: a successful model

Journal of Virus Eradication ◽

10.1016/s2055-6640(20)30801-3 ◽

2017 ◽

Vol 3 ◽

pp. 32

Author(s):

S. Sheils ◽

S. Mason ◽

F. Tenison ◽

M. Gawrys ◽

J. Pritchard-Jones ◽

...

Keyword(s):

Primary Care ◽

Hepatitis C ◽

Primary Care Providers ◽

Care Providers ◽

Hepatitis C Treatment ◽

Successful Model ◽

Treatment Uptake

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Screening, Diagnosis, Treatment, and Management of Hepatitis C: A Novel, Comprehensive, Online Resource Center for Primary Care Providers and Specialists

The American Journal of Medicine ◽

10.1016/j.amjmed.2014.10.004 ◽

2014 ◽

Vol 127 (11) ◽

pp. e11-e14 ◽

Cited By ~ 6

Author(s):

Edward Lebovics ◽

Klara Czobor

Keyword(s):

Primary Care ◽

Hepatitis C ◽

Primary Care Providers ◽

Care Providers ◽

Resource Center ◽

Online Resource

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A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments

BMC Health Services Research ◽

10.1186/s12913-019-4635-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 15

Author(s):

Andrew Radley ◽

Emma Robinson ◽

Esther J. Aspinall ◽

Kathryn Angus ◽

Lex Tan ◽

...

Keyword(s):

Primary Care ◽

Hepatitis C ◽

Meta Analysis ◽

Antiviral Drug ◽

Sustained Viral Response ◽

Primary Care Providers ◽

Care Providers ◽

Hcv Treatment ◽

Direct Acting Antiviral ◽

Direct Acting

Abstract Background Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. Methods Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). Results Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). Conclusion Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.

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A Hepatitis C Educational Needs Assessment of Canadian Healthcare Providers

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2017/5324290 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Reza Naghdi ◽

Karen Seto ◽

Carolyn Klassen ◽

Didi Emokpare ◽

Brian Conway ◽

...

Keyword(s):

Primary Care ◽

Hepatitis C ◽

Needs Assessment ◽

Primary Care Physicians ◽

Healthcare Providers ◽

Public Health Problem ◽

Primary Care Providers ◽

Educational Needs ◽

Major Public Health Problem ◽

Care Providers

Background and Aim. Despite advances in the treatment of chronic hepatitis C infection (CHC), it remains a major public health problem in Canada and globally. The knowledge of healthcare providers (HCPs) is critical to improve the care of CHC in Canada. To assess the current knowledge and educational needs of healthcare providers (HCPs) in the area of CHC management a national online survey was conducted. Method. An interprofessional steering committee designed a 29-question survey distributed through various direct and electronic routes. The survey assessed several domains (e.g., participant and practice demographics, access to resources, knowledge of new treatments, and educational preferences). Results. A total of 163 HCPs responded to the survey. All hepatologists and 8% of primary care providers (PCPs) reported involvement in treatment of CHC. Physicians most frequently screened patients who had abnormal liver enzymes, while nurses tended to screen based on lifestyle factors. More than 70% of PCPs were not aware of new medications and their mechanisms. Conclusion. Overall, the needs assessment demonstrated that there was a need for further education, particularly for primary care physicians, to maximize the role that they can play in screening, testing, and treatment of hepatitis C in Canada.

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P.489 Educating primary care providers about hepatitis C

Journal of Clinical Virology ◽

10.1016/s1386-6532(06)80662-1 ◽

2006 ◽

Vol 36 ◽

pp. S212

Author(s):

D.H. Winston ◽

D.C. Winston

Keyword(s):

Primary Care ◽

Hepatitis C ◽

Primary Care Providers ◽

Care Providers

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A Primary Care-based Collaborative Hepatitis C Clinic: Clinical Structure and Virologic Outcomes with Direct Acting Antiviral Therapy

Open Medicine Journal ◽

10.2174/1874220301603010070 ◽

2016 ◽

Vol 3 (1) ◽

pp. 70-78

Author(s):

Samuel B. Ho ◽

Adrian Dollarhide ◽

Hilda Thorisdottir ◽

James Michelsen ◽

Christine Perry ◽

...

Keyword(s):

Primary Care ◽

Hepatitis C ◽

Adverse Events ◽

Nurse Practitioners ◽

Primary Care Providers ◽

Care Providers ◽

Care Clinic ◽

Number Of Patients ◽

Direct Acting ◽

Collaborative Primary Care

Background: Currently 4 million persons in the US have active hepatitis C virus (HCV) infection and most have never successfully completed antiviral treatment. Newer therapies herald potential for wider uptake and acceptance of treatment, but the number of hepatology specialists is limited and newer models are needed to increase access to care. The aim of this study is to describe a collaborative primary care-based clinic for HCV treatment. Methods: Retrospective analysis of a collaborative primary care clinic developed for the evaluation and treatment of patients with chronic hepatitis C at one VA medical center. A half-day clinic was organized with 4 primary care MDs, 2 hepatologists, 2 nurse practitioners, and a co-located psychiatrist, pharmacist and nurse case manager. Clinic productivity and outcomes related to the number of patients who initiated and completed treatment with direct acting antivirals (DAA) and pegylated interferon and ribavirin were evaluated. Results: In this 18 month period, the clinic had 1890 confirmed HCV registry patients and 1690 clinic visits. 74 HCV genotype 1 patients initiated DAA therapy. Primary care providers treated 47 patients (32% cirrhotic) and hepatologists treated 27 patients (48% cirrhotic). Final SVR rate was 54.6% (39.2% cirrhotics vs. 65.2% noncirrhotics). SVR rates were higher in patients with primary care providers (61.7%) vs. hepatologists (44.4%). Despite numerous adverse events, early treatment termination for adverse events occurred in 5.3% vs. 21.3% for virologic non-response. Multivariate analysis revealed no significant differences between primary care and hepatology for SVR and treatment discontinuations. Conclusion: This clinic demonstrated effectiveness and safety with DAA therapy. This illustrates potential for a primary care based collaborative clinic, which will be crucial for expanding access to effective HCV care.

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