Patients in rural areas under the care of local primary care physicians (PCPs), and who were diagnosed with the Hepatitis C virus were more likely to receive treatment if their physicians participated in telemedicine conferencing with infectious disease specialists, according to a new report published in the American Journal of Medicine.1
In the Department of Veteran’s Affairs (VA) healthcare system, the rate of chronic hepatitis C is nearly 3 times that in the general population, making this an excellent study population.2 Lauren Beste, MD, MSc, of the VA Office of HIV, Hepatitis C, and Public Health Pathogens and colleagues from multiple health centers identified a cohort of 6431 patients with hepatitis C from 152 US VA sites who had a PCP who participated in the VA ECHO telemedicine project. They found a 21.4% treatment rate in VA-ECHO-exposed patients compared with only 2.5% in a much greater population who were unexposed (n = 32,322).
As the largest provider in the United States of treatment for hepatitis C, the VA became the first system in 2011 to incorporate the ECHO telemedicine model into national practice.3 “VA-ECHO is a provider-to-provider telementorship model, meaning that the patient does not participate personally in the conference,” explained Dr Beste. “After the specialist (who is typically a gastroenterologist/hepatologist or infectious disease specialist) and the PCP discuss the case on a VA-ECHO call, the PCP then implements the care plan with the patient.”
Approximately 37.9% of VA healthcare users live in rural or highly rural areas that do not support specialty medicine.4 The study authors found that offering specialty telemedicine to PCPs serving these populations produced similar outcomes to treatment by specialists, without a loss in the quality of care. The combined sustained virologic response rate (SVR) to antiviral therapies was 58.2% in VA-ECHO-exposed patients compared with 53.9% in unexposed patients. Duration of treatment and SVRs in both groups treated by PCPs were similar to those in patients treated by specialists.
The investigators considered that patients with hepatitis C might even perceive there to be fewer communication barriers with their regular PCPs than with specialists, contributing to the substantial increase in treatment rates, and this suggested a strong willingness on the part of the patients to adhere to therapies. “We saw no meaningful differences in duration of therapy, based on pharmacy data, between patients who used telemedicine vs traditional face-to-face care. This suggests that patients who use VA-ECHO do not tend to drop out of treatment earlier than usual,” Dr Beste said.
Further study is necessary to evaluate the cost-effectiveness and sustainability of a full scale national roll-out of the VA-ECHO program, the investigators reported.
- Beste LA, Glorioso TJ, Ho PM, et al. Telemedicine specialty support promotes hepatitis c treatment by primary care providers in the Department of Veterans Affairs [published online December 17, 2016]. Am J Med. doi: 10.1016/j.amjmed.2016.11.019
- Beste LA, Ioannou GN. Prevalence and treatment of chronic hepatitis C virus infection in the US Department of Veterans Affairs. Epidemiol Rev. 2015;37:131-143. doi: 10.1093/epirev/mxu002
- Kirsh S, Su GL, Sales A, Jain R. Access to outpatient specialty care: solutions from an integrated health care system. Am J Med Qual. 2015;30:88-90. doi: 10.1177/1062860614542844
- West AN, Lee RE, Shambaugh-Miller MD, et al. Defining “rural” for veterans’ health care planning. J Rural Health. 2010;26:301-309. doi: 10.1111/j.1748-0361.2010.00298.x