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

Methods

This was a retrospective cohort study evaluating the efficacy of using an eConsult system to cure HCV in SFHN patients being treated in primary care settings. We analysed all patients who were treated for HCV with DAAs through 10 primary care medical clinics between January 1, 2017 and August 3, 2019. Patients were included if they had HCV and were started on HCV treatment, defined as prescription of a DAA. We excluded patients who received HCV treatment through speciality care (eg hepatology) since they may have had decompensated cirrhosis, history of liver transplant, or additional complications preventing treatment in primary care. Patients were also excluded if they received HCV treatment in SFHN's skilled nursing and rehabilitation centre. Lastly, patients were excluded if they received treatment through clinics without access to the eConsult system due to the inability to review those patients' medical records, or if they were treated with non-DAAs or with interferon (Figure 1). Of the included patients, we compared the number of patients who achieved SVR12 through the eConsult system with those who were treated independent of an eConsult within primary care. This study was IRB approved with a waiver for informed consent.

Figure 1.

Flowchart of study population

The eConsult

The eConsult process begins when a PCP submits background information and questions for the pharmacist in a secure, electronic format which is linked to the medical record. The pharmacist reviewer then replies through the eConsult system with patient-specific recommendations. If the pharmacist wants confirmation of a treatment plan or has additional questions, these are passed on to the physician HCV subject matter expert for review. The dialogue is bidirectional between the PCP and pharmacist to allow for additional questions as needed. The content of each eConsult becomes part of the patient's electronic medical record. See Appendix S1 for a depiction of the primary care HCV treatment eConsult platform.

Data Collection

Data were collected from electronic medical records for all patients treated for HCV with DAAs in primary care. The following variables were collected: age at the time of treatment, sex, race, prescribing clinic, HCV treatment prescriber type, DAA prescribed, most recent AST, ALT, and platelets prior to starting treatment, most recent HCV viral load, receipt of an eConsult, and treatment recommendation through the eConsult (if provided). Of note, the HCV treatment prescriber was documented as the type of provider who wrote the initial prescription (eg nurse practitioner, physician and pharmacist). All patients underwent chart review by a pharmacist to verify if SVR12 laboratories were obtained and to assess and verify presence of cirrhosis utilizing imaging.

Analysis

The intent-to-treat (ITT) analysis included all patients who met inclusion criteria while the per protocol (PP) analysis excluded patients who did not obtain a viral load at least twelve weeks after treatment. We chose to complete two separate analyses to account for patients who did not complete a viral load test 12 weeks after finishing treatment since we could not accurately identify whether these patients achieved SVR12, the definitive test for HCV cure. The primary outcome of SVR12 was analysed using the chi-square test. Age was evaluated using the student t-test, while all other variables including race, liver status, prescriber type, and medication type were evaluated using the chi-square test.

processing....