Statewide hepatitis <scp>C</scp> model of care for rural and remote regions

Cheng, Wendy; Nazareth, Saroja; Flexman, James

doi:10.1111/jgh.12863

Cited by 12 publications

(7 citation statements)

References 11 publications

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“…Telehealth was considered highly effective and a viable option when supported by appropriately trained health professionals and clear treatment protocols. This finding was consistent with another WA study [ 22 ] and the findings of Project ECHO (Extension for Community Healthcare Outcomes) which found treatment of HCV patients at 21 rural ECHO sites and prisons in New Mexico using telehealth to be comparable to treatment of patients at an HCV clinic in reaching a sustained virological response [ 21 ].…”

Section: Discussionsupporting

confidence: 90%

Evaluation of the regional nurse-supported hepatitis C shared care program in Western Australia: a mixed methods study

Lobo

Mascarenhas

Worthington

et al. 2015

BMC Health Serv Res

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BackgroundNurse-supported shared care services for patients living with hepatitis C have been implemented in some regional areas of Western Australia to provide access to local treatment and care services for patients and to improve currently low levels of treatment uptake. This study collected data from health professionals involved in managing the care of patients living with hepatitis C and from patients engaged in regional nurse-supported hepatitis C shared care services in Western Australia.MethodsKey informant qualitative interviews were conducted with health professionals in regions operating a nurse-supported shared care service and in regions without this service. Patients engaged in the shared care program at the time of the study were invited to complete a short questionnaire.ResultsNurse-supported shared care services reduced patient transport costs to tertiary centres, accelerated access to treatment and delivered >98 % compliance with treatment schedules. Patients engaged with regional hepatitis C shared care services expressed high levels of satisfaction and indicated that they would delay treatment if it was not available locally. Telehealth support from tertiary liver clinics and allied health services were available to health professionals engaged in regional shared care services and were used effectively. There was limited participation by general practitioners in regional hepatitis C shared care services and regional patients’ access to treatment was influenced by the availability and capacity of health professionals. Uptake of treatment and engagement in the regional shared care program was limited for Aboriginal people and younger people although these groups had the highest rates of hepatitis C notifications in Western Australia.DiscussionThe patients consulted for this study preferred to access hepatitis C treatment and care locally rather than travel to tertiary liver clinics, up to 1500 kilometres away. The reasons for limited engagement in the shared care program by some groups with high rates of hepatitis C notifications requires further investigation. Health professionals identified several benefits of the shared care program including continuity of care for patients, shorter waiting times, longer appointment times and high levels of treatment compliance.ConclusionsHepatitis nurses in regional areas can coordinate effective patient treatment and care when supported by treatment protocols and access to physicians and liver specialists, including through telehealth. Treatment and care options to suit individual preferences are required to avoid further stigmatising marginalised groups. The role of primary care in facilitating hepatitis C treatment uptake should be explored further including strategies for improving the participation of general practitioners in regional shared care services.

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Section: Discussionsupporting

confidence: 90%

Evaluation of the regional nurse-supported hepatitis C shared care program in Western Australia: a mixed methods study

Lobo

Mascarenhas

Worthington

et al. 2015

BMC Health Serv Res

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“…Liver disease also contributed to aeromedical retrievals for GI disorders (3.6%; n = 217). This finding is consistent with research that indicates that rural and remote populations have higher rates of untreated hepatitis C and increased prevalence of excessive alcohol consumption, both of which are linked to liver cirrhosis and cancer . This, coupled with the increasing rates of substance use disorders requiring aeromedical retrieval, indicates a complex clinical environment …”

Section: Discussionsupporting

confidence: 89%

Aeromedical retrievals for gastrointestinal disorders in rural and remote Australia: the need for improved access to specialist advice

Gardiner

Bishop

McMahon

et al. 2020

Internal Medicine Journal

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et al. Effect of tacrolimus and cyclosporine A on suppression of albumin secretion induced by inflammatory cytokines in cultured human hepatocytes. Inflamm Res 2006; 55: 216-20. 18 Ramachandran R, Hn HK, Kumar V, Nada R, Yadav AK, Goyal A et al. Tacrolimus combined with corticosteroids versus modified Ponticelli regimen in treatment of idiopathic membranous nephropathy: randomized control trial. Nephrology (Carlton) 2016; 21: 139-46. AbstractThe Royal Flying Doctor Service (RFDS) provides medical care to populations without access to traditional health-care services. From 2014 to 2018 the RFDS conducted 6007 (≈1201/year) aeromedical retrievals for gastrointestinal (GI) disorders. More detailed research is needed to determine specific GI disorders that contributed to this caseload, and in particular inform whether the establishment of a GI specialist service is justified.There is little research on the rates of gastrointestinal (GI) disorders in rural and remote Australia. While there have been rural and remote studies on specific conditions, such as colorectal cancer, 1 there is no literature

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“…Some local health districts in New Zealand have implemented incentives for GPs who provide HCV treatment in a primary care setting, 20 and in Australia this strategy is being used on an ad hoc basis for some patient groups. Models of care using nurse practitioners upskilled in the treatment of HCV and telehealth services supported by specialists may help improve treatment rates, particularly in remote areas with limited access to GP or specialist services 21,22 . Findings of a recent study from South Australia showed that models of care that include GPs or mixed consultant nurse models are cost‐effective ways of promoting HCV treatment uptake 23 .…”

Section: Discussionmentioning

confidence: 99%

The changing characteristics of patients with chronic hepatitis C prescribed direct acting antiviral medicines in general practice since listing of the medicines on the Australian Pharmaceutical Benefits Scheme

Busingye¹,

Chidwick²,

Simpson³

et al. 2021

JGH Open

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Background and Aim The primary objective of this study was to determine whether the characteristics of patients prescribed direct acting antiviral (DAA) medicines have changed since initial listing of the medicines on the Australian Pharmaceutical Benefits Scheme (PBS). Methods A cross‐sectional study was conducted using data from MedicineInsight, an Australian database of general practice electronic health records, from March 2016 to August 2018. We compared sociodemographic, comorbidity, and clinical characteristics of patients aged at least 18 years who were prescribed at least one DAA in the first 4 months of PBS listing in 2016 with those prescribed at least one DAA in 2018. Results There were 2251 eligible adult patients prescribed a DAA during the study period, 62% were men and 59% were aged 50 years and older. Patients prescribed DAA medicines initially were older (aged ≥50 years: 67.9% vs 49.3%; P < 0.001), and more likely to have liver cirrhosis (14.2% vs 8.4%; P = 0.01) and an aminotransferase to platelet ratio index (APRI) score >1 (20.4% vs 8.9%; P < 0.001) than those prescribed DAA medicines in 2018. A greater proportion of patients in regional/remote (46.5% vs 35.6%; P < 0.001) and socioeconomically disadvantaged areas (44.4% vs 34.5%; P = 0.003) accessed treatment in 2018 compared with 2016. Conclusions Despite evidence of decreasing uptake of DAA medicines across Australia, this study indicates broadened uptake among younger age groups and those residing in regional/remote and socioeconomically disadvantaged areas since 2016. While uptake of DAA medicines in some population subgroups appears to have improved, continuous efforts to improve uptake across the Australian population are essential.

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Statewide hepatitis C model of care for rural and remote regions

Cited by 12 publications

References 11 publications

Evaluation of the regional nurse-supported hepatitis C shared care program in Western Australia: a mixed methods study

Evaluation of the regional nurse-supported hepatitis C shared care program in Western Australia: a mixed methods study

Aeromedical retrievals for gastrointestinal disorders in rural and remote Australia: the need for improved access to specialist advice

The changing characteristics of patients with chronic hepatitis C prescribed direct acting antiviral medicines in general practice since listing of the medicines on the Australian Pharmaceutical Benefits Scheme

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