Communication and collaborative use of technology by physicians who serve underserved populations and by specialists can enhance patient management and treatment of hepatitis C virus infection, according to a report released May 8 by the Centers for Disease Control and Prevention.
Researchers analyzed programs in Utah and Arizona aimed at improving access to primary care providers with the capacity to manage and treat HCV infection. Both programs were modeled after the Extension for Community Healthcare Outcomes (Project ECHO) developed by the University of New Mexico’s Health Sciences Center in 2003. The initiative builds primary care providers’ capacity to treat diseases through videoconferencing and case-based learning in "teleECHO" clinics (MMWR 2014;63:393-8).
From Sept. 30, 2012, to Feb. 28, 2014, the Utah and Arizona programs trained 66 primary care clinicians, predominantly from rural settings. Ninety-three percent of the providers had no prior experience in care and treatment of HCV infection. Primary care clinicians attended weekly teleECHO sessions with specialists after an initial HCV training. Utah’s team of specialists included a hepatologist, psychiatrist, and pharmacist; Arizona’s team consisted of a hepatologist and nurse practitioner. Through videoconferencing, clinicians presented their HCV cases to specialists who provided advice and clinical mentoring.
A total of 280 unique cases of chronic HCV infection were presented in teleECHO sessions. In both states, a combined 46% of the HCV-infected patients received antiviral treatment, more than doubling the proportion of patients expected to receive treatment. Of the 46%, nearly three-quarters were treated with an interferon-based regimen and 26% were treated with a regimen containing sofosbuvir, a drug approved in December 2013.
The study’s authors concluded that Project ECHO is a model that can significantly enhance primary care provider capacity to treat HCV infection among underserved populations, including the use of newly approved medications. Collaborations with specialists will help primary care providers to incorporate new treatments for HCV infection, the investigators noted, and will be an important measure for improving access and reducing barriers to treatment.