Efficacy of an eConsult Service to Cure Hepatitis C in Primary Care

Jacey Nishiguchi; Anusha McNamara; Colleen S. Surlyn; Kellene Vokaty Eagen; Laura Feeney; Vivian Lian; David E. Smith

Disclosures

J Viral Hepat. 2022;29(1):21-25. 

In This Article

Abstract and Introduction

Abstract

In 2016, an eConsult service was developed within a safety net health system to expand access to hepatitis C (HCV) treatment in the primary care setting. The eConsult system provides individualized treatment recommendations from specially trained primary care pharmacists and primary care physicians to primary care providers with less experience in the rapidly changing treatment of HCV. Since its launch, this service has had a large impact in expanding care to a largely homeless and low-income urban population within our health system. We now aim to evaluate its efficacy in curing HCV. In this retrospective cohort study, we describe rates of sustained virologic response 12 weeks after treatment completion (SVR12) for those who received primary care-based HCV treatment through the eConsult system with those who were treated in primary care independent of an eConsult from 2017 to 2019. We found there was no significant difference in the proportion of patients who achieved SVR12 between the two groups. Overall, >90% of patients who received treatment achieved SVR12. Approximately 40% of patients treated for HCV received an eConsult, suggesting utility of the eConsult in expanding access and coordinating treatment for patients within our network.

Introduction

The World Health Organization estimates that approximately 71 million people worldwide have chronic hepatitis C viral infection (HCV).[1] In the U.S. alone, the CDC estimates approximately 3.5 million people are living with HCV.[2] Half of those infected are diagnosed and aware of their infection; of those, only a fraction receive care and achieve cure.[3] The complications of HCV include liver cirrhosis and hepatic carcinoma along with decreased quality of life and risk of transmission to others.[3] Use of interferon-free oral direct acting agents (DAAs) have a success rate of achieving sustained virologic response at twelve weeks post-treatment (SVR12) in over 95% of patients and offer an opportunity to prevent the aforementioned complications in individuals with HCV.[4] Several studies[5,6] have evaluated the efficacy of treating patients with chronic HCV in primary care settings, as opposed to speciality settings, and found no difference in SVR12 between the two settings.

The primary care-based HCV treatment eConsult of San Francisco Health Network (SFHN) is used by primary care providers (PCPs) in adult primary care clinics to receive individualized treatment recommendations from pharmacists and primary care doctors experienced in HCV treatment. SFHN is an urban safety net healthcare system composed of a tertiary care hospital, skilled nursing and rehabilitation centre, and primary care clinics in 14 locations that serve 63,000 patients. The eConsult service was created in 2016 as an intervention in primary care settings to improve access for patients to HCV treatment. Knowledge deficits regarding HCV risk factors, prevention, and management among PCPs coupled with limited availability of specialists have been previously identified as barriers to treatment.[7] This intervention aimed to address these barriers by providing the most up to date and evidence-based recommendations to PCPs without the need for a specialist. This eConsult service allows PCPs to confidently treat patients themselves without requiring patient interaction with a specialist, while still allowing for consultation with subject matter experts.

Previously, an evaluation was conducted to assess the impact of this eConsult service in expanding treatment after its development in 2016.[8] It found that after implementation of trainings and the eConsult service, the number of patients treated in primary care tripled and the number of primary care clinics providing HCV treatment increased from 5 to 12 over the course of 3 years. The eConsult service has had a large impact in expanding care and access to HCV treatment within our health system, which serves the majority of the low-income and homeless populations in San Francisco; we now aim to evaluate its efficacy in curing HCV.

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