Show Me Echo – Hepatitis C: A telemedicine mentoring program for patients with hepatitis C in underserved and rural areas in Missouri as a model in developing countries

Tahan, Veysel; Almashhrawi, Ashraf; Mutrux, Rachel; Ibdah, Jamal A.

doi:10.5152/tjg.2015.159000

Cited by 17 publications

(13 citation statements)

References 5 publications

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“…Results from this study indicate that telementoring can increase capacity to treat HCV in correctional facilities. This is comparable to reports by HCV telementoring services in other countries, 13 as well as telementoring services in other specialties. 11 Furthermore, results from this study indicate that an HCV therapy telementoring service is likely to reduce the per capita cost of treating HCV in this setting.…”

Section: Discussionsupporting

confidence: 87%

Telementoring for hepatitis C treatment in correctional facilities

et al. 2018

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Introduction Prevalence of hepatitis C virus (HCV) is substantially higher among prisoners than the general population. In Australia until recently, only a small proportion of prisoners with HCV received antiviral therapy. The direct-acting antivirals (DAAs) for HCV are highly effective, with a low burden of side effects. Since 2016, DAAs are available to all Australians with HCV. However, currently in Australia, they can only be prescribed by or in consultation with experienced prescribers. This study evaluated a telementoring service to upskill doctors and nurse practitioners working in correctional facilities. Methods The telementoring service was implemented in five correctional facilities. Qualitative interviews were used to examine the perceived clinical effectiveness and organisational impacts of the service. Content analysis of the interviews was used to identify key themes. Results In the first ten months of the service, there were 16 telementoring sessions with 173 patients discussed. Sixteen staff participated in qualitative interviews. From these, three key themes were identified: access to antiviral therapy; organisational impacts (cost, increased staff knowledge and confidence, staff time, and workload); and, adaptations of the care model and future opportunities. Conclusion Telementoring is an effective method to facilitate eligible prescriber status to medical doctors and upskill other clinicians in correctional facilities to increase capacity to treat HCV.

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Section: Discussionsupporting

confidence: 87%

Telementoring for hepatitis C treatment in correctional facilities

et al. 2018

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“…Telemedicine-delivered HCV services have been suggested as a means to increase access for remote populations and to reduce the financial strain on patients seeking HCV care and treatment (14). Telemedicine services have been used in marginalized populations residing in underserviced areas and have achieved similar clinical outcomes as services obtained in traditional clinic settings (15)(16)(17). In addition to comparable clinical outcomes, evidence suggests that there are additional benefits to using telemedicine services, including decreased wait time for specialty care, decreased health care expenditures, improved patient follow-up, and improved patient experience as a result of comprehensive continuity of care (1,(18)(19)(20)(21).…”

Section: Definition Of Hcv Care Delivery Methodsmentioning

confidence: 99%

Telemedicine successfully engages marginalized rural hepatitis C patients in curative care

Lepage

Garber

Corrin

et al. 2020

Official Journal of the Association of Medical Microbiology and

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Background: Rurally located individuals living with hepatitis C virus (HCV) face barriers to engagement and retention in care. Telemedicine technologies coupled with highly curative direct acting antiviral (DAA) treatments may increase accessibility to HCV care while achieving high sustained virologic response (SVR) rates. We compared clinical and socio-economic characteristics, SVR, and loss to follow-up among telemedicine (TM), mixed delivery (MD), and outpatient clinic (OPC) patients receiving care through The Ottawa Hospital Viral Hepatitis Program (TOHVHP). Methods: TOHVHP clinical database was used to evaluate patients engaging HCV care between January 1, 2012, and December 31, 2016. SVR rates by HCV care delivery method (TM versus OPC versus MD) were calculated. Results: Analysis included 1,454 patients who engaged with TOHVHP at least once. Patients were aged almost 50 years on average and were predominately male and Caucasian. A greater proportion of TM patients were rurally based, were Indigenous, had a history of substance use, and had previously been incarcerated. Per-protocol DAA SVR rates for TM, OPC, and MD patients were 100% (26/26), 93% (440/472), and 94% (44/47), respectively. Loss-to-follow-up rates for HCV-treated TM and MD patients were higher (27% [10/37], 95% CI 0.58 to 0.88, and 11% [7/62], 95% CI 0.81 to 0.97, respectively) than for those followed exclusively in the OPC (5% [39/800], 95% CI 0.94 to 0.97). Conclusions: TM can successfully engage, retain, and cure rurally based HCV patients facing barriers to care. Strategies to improve TM retention of patients initiating HCV antiviral treatment are key to optimizing the impact of this model of care.

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“…In 2015, the University of Missouri-Columbia also adapted the ECHO model (renamed to Show Me ECHO) to train and mentor primary care physicians treating patients with HCV in rural and underserved areas of Missouri;18 this report subjectively stated the benefits of utilizing the ECHO model (“increased the number of [primary care physicians] who are confident in their ability to diagnose and treat HCV-infected patients,” and “increased number of persons detected with [and treated for] HCV…in the targeted geographical areas of the project”). The ECHO model is a promising alternative approach in the era of DAA agents to minimize specialist referrals by educating primary care physicians who manage patients with HCV in rural areas and in prisons via weekly video-conferencing ( i.e .…”

Section: Other Treatment Models For Hcv Treatmentmentioning

confidence: 99%

Expanding Treatment Access for Chronic Hepatitis C with Task-shifting in the Era of Direct-acting Antivirals

Yoo

Perumpail

Cholankeril

et al. 2017

Journal of Clinical and Translational Hepatology

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In the United States, the fight to eradicate hepatitis C virus (HCV) infection has been ongoing for many years, but the results have been less than ideal. Historically, patients with chronic hepatitis C (CHC) were treated with interferon-based regimens, which were associated with frequent adverse effects, suboptimal response rates, and long durations of treatment – of up to 48 weeks. Expertise from specialist-physicians, such as hepatologists and gastroenterologists, was needed to closely follow patients on these medications so as to monitor laboratory values and manage adverse effects. However, the emergence of direct-acting antiviral (DAA) agents against HCV infection have heralded outstanding progress in terms of safety, tolerability, lack of adverse effects, efficacy, and truncated duration of therapy – 12 weeks or less – thereby making the need for close monitoring by specialist-physicians obsolete. With the recent approval of DAA agents by the Food and Drug Administration, the treatment model for CHC no longer relies on the limited number of specialist-physicians, which represented a major barrier to treatment access in the past, especially in underserved areas of the United States. We propose and share our experiences in adapting a task-shifting treatment model, one that utilizes a relatively larger pool of non-specialist healthcare providers, such as nursing staff (medical assistants, vocational licensed nurses, registered nurses, etc.) and advanced practice providers (nurse practitioners and physician assistants), to perform a variety of important clinical functions in an effort to make DAA-based antiviral therapy widely available against HCV infection. Most recently, task-shifting was implemented by the United States and World Health Organization in the fight against the human immunodeficiency virus and showed encouraging results. Based on our experiences in implementing this model at our outreach clinics, the majority of HCV-infected patients treated with DAA agents can be easily monitored by non-specialist healthcare providers and physician extenders. Task-shifting can effectively address one of the major rate-limiting factors in expanding treatment access for HCV infection.

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Show Me Echo – Hepatitis C: A telemedicine mentoring program for patients with hepatitis C in underserved and rural areas in Missouri as a model in developing countries

Cited by 17 publications

References 5 publications

Telementoring for hepatitis C treatment in correctional facilities

Telementoring for hepatitis C treatment in correctional facilities

Telemedicine successfully engages marginalized rural hepatitis C patients in curative care

Expanding Treatment Access for Chronic Hepatitis C with Task-shifting in the Era of Direct-acting Antivirals

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