Hepatitis C: Project Links Experts, Primary Care Physicians

Larry Hand

May 09, 2014

A CDC-sponsored project in Utah and Arizona successfully trained primary care physicians in rural or underserved areas to test and treat patients with hepatitis C (HCV), according to an article published in the May 9 issue of the Morbidity and Mortality Weekly Report.

The program links community physicians with specialists and provides regular collaboration on case studies through videoconferencing, report Kiren Mitruka, MD, from the Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues.

HCV Programs

The CDC funded the Utah and Arizona programs in September 2012. The programs were modeled after the University of New Mexico's Extension for Community Healthcare Outcomes (Project ECHO [Extension for Community Healthcare Outcomes]), a program developed to expand care for rural, underserved populations through videoconferencing and case study collaboration in what are called teleECHO sessions.

Overall, 66 primary care physicians, 93% of whom had no experience in HCV care and treatment, received training through the Utah and Arizona Project ECHO programs. In weekly teleECHO "clinics," the local physicians presented case reports and collaborated with specialists through videoconferencing.

Between September 30, 2012, and February 28, 2014, the primary care physicians, mostly from rural areas and community health centers, presented 280 unique cases of chronic HCV infection. Cases in both states were primarily US-born, non-Hispanic white and were born between 1945 and 1965.

Of 129 (46.1%) patients who started treatment, 91 (70.5%) were treated with an interferon-based treatment, and 34 (26.4%) were treated with a regimen containing sofosbuvir, a new drug approved in December 2013.

The authors note that the proportion of patients who initiated treatment in the Project ECHO programs was nearly twice the proportion predicted to receive treatment based on previous data.

"We believe in this kind of model that enhances primary care doctors who have a rapport with the patient — they're on the front lines — if they have the capacity to not only test but cure, so that patients aren't lost in the healthcare system going from being diagnosed to getting treatment started," Dr. Mitruka told Medscape Medical News.

More Diagnoses on the Horizon

Because the CDC expanded screening recommendations in 2012 to include all persons born between 1945 and 1965, she added, "What we're anticipating is potentially a surge in the diagnosis of [HCV] infection. One of the concerns we have is how do we link people to care once they're diagnosed."

She continued, "We need innovative efforts to build capacity of providers to care for patients who have HCV infection at a time when we're seeing tremendous progress in well-tolerated curative therapies. We certainly know that no one entity can implement this alone. What this requires is partnership among primary care providers with an interest in capacity building to treat HCV, along with experts in HCV treatment, as well as public health when it comes [to] ensuring management of HCV."

The Project ECHO model, which is evidence-based, has been evaluated in a research study and has been found to be produce similar results as a comparison group of patients treated at an academic medical center.

"What we were able to show is that these 2 states were able to replicate the model," Dr. Mitruka said.

Possible limitations of the analysis include the possible lack of generalizability to other states because both Utah and Arizona had already started Project ECHO-based program development during the year, before September 2012.

"Collaborations with specialists will help primary care providers to begin to incorporate new treatments for HCV infection and will be an important measure for improving access and reducing barriers to treatment. The results of this evaluation demonstrate Project ECHO as a model that can enhance primary care provider capacity to treat HCV infection among underserved populations, including the use of newly approved medications," the researchers conclude."

Morb Mortal Wkly Rep. 2014;63:393-398, 399-401. Mitruka full text, Beckett full text

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