Primary care model helps treat underserved patients with hepatitis C virus infection
Research Activities, November 2011
An estimated 3.2 million Americans live with chronic hepatitis C virus (HCV) infection that can lead to cirrhosis and liver cancer. Treatment is available, although its complex nature means that specialists usually provide care. Yet a new study shows that, with proper training and the use of video conferencing, primary care providers at community-based health centers can extend this treatment to underserved groups. Called the Extension for Community Healthcare Outcomes (ECHO) model, the program takes advantage of telehealth technology to deliver training, advice, and support on optimal clinical care to patients with HCV infection. Clinicians at each community provider site participate in weekly HCV clinics in which they present their cases to key specialists at a major academic medical center. Sanjeev Arora, M.D., of the University of Mexico, and colleagues looked at 21 ECHO sites in rural areas and prisons in New Mexico involving 407 patients with chronic HCV infection, who started treatment at these sites. Participating patients received standard treatment consisting of peginterferon and ribavirin for either 24 or 48 weeks depending on the type of HCV infection they had.
More than half (58.2 percent) of patients at the ECHO sites had a sustained response to treatment. This rate was similar for patients receiving treatment at the HCV clinic at the academic medical center (57.5 percent). However, patients at the ECHO sites experienced less serious adverse events (6.9%) than at the academic HCV clinic (13.7 percent). According to the researchers, the ECHO model can be replicated elsewhere at other community health centers with the collaboration of local academic specialists and the use of telehealth technology. The study was supported in part by the Agency for Healthcare Research and Quality (HS16510). See "Outcomes of treatment for hepatitis C virus infection by primary care providers," by Sanjeev Arora, M.D., Karla Thornton, M.D., Glen Murata, M.D., and others in the June 9, 2011 The New England Journal of Medicine 364(23), pp. 2199-2207.