Specially trained primary care providers can offer effective
and safe treatment for hepatitis C infection, US investigators report in the New England Journal of Medicine.
Rates of sustained virological response were the same for
patients who received therapy from primary care providers as individuals who
received treatment at a specialist clinic.
The primary care providers were given specialist training
and support using video and telephone conferencing. This training, called the
Extension for Community Healthcare Outcomes (ECHO) model, was developed by
doctors at the University of New Mexico (UNM) Health Sciences Center.
They were concerned that a large proportion of patients in
New Mexico with chronic hepatitis C were not receiving therapy for their
infection. Especially low rates of treatment were seen in patients living in
rural areas, as well as those from minority populations, and those in prison.
“In 2004, patients from rural areas had to wait up to 6
months for an appointment at the HNM HCV clinic and had to travel up to 250
miles,” comment the authors, adding, “as of 2003, not a single patient in the
correctional system had received treatment for HCV infection.”
Using state-of-the-art video and teleconfering facilities,
specialist staff from the UNM HCV clinic trained primary care providers to
deliver hepatitis C therapy.
Investigators wished to see if treatment provided according
to the ECHO model was as effective and safe as therapy delivered at the
specialist UNM clinic.
They therefore compared treatment outcomes (the proportion
of patients achieving a sustained virological response) between the two types
of service providers, and also gathered information on the frequency of
side-effects.
“Our hypothesis was that when treatment for hepatitis C
infection is delivered in the community (or prison) with the use of the ECHO
model, it is as effective as that provided by an academic medical center,”
comment the investigators.
The study involved 407 adult patients whose hepatitis was
treated between 2004 and 2008. A total of 246 of these patients received
therapy at the 21 ECHO centres (five in prisons) that participated in the
research.
Almost identical proportions of patients at the ECHO sites
and specialist clinic achieved a sustained virological response (58.2% vs.
57.5%).
Treatment outcomes were also comparable for patients with
the hard-to-treat genotype-1 infection (rate of sustained virological response:
ECHO, 49.7% vs. clinic, 45.8%).
Serious side-effects were more common among patients treated
at the clinic than those cared for at ECHO sites (13.7 vs. 6.9%, p = 0.02). In
addition, clinic patients were more likely to have side-effects leading to the
termination of therapy (8.9% vs. 4.2%, p = 0.05).
“We found that treatment for HCV infection delivered with
the use of the ECHO model was associated with high rates of cure,” write the
authors, who also note “we met our goal of increasing treatment for minority
and other underserved patients.”
They believe that the ECHO model can bring “to the rural
clinician the expertise and clinical resources that may not otherwise be
available, thus positively affecting the outcomes.”
The investigators conclude: “The ECHO model has the
potential for being replicated elsewhere in the United States and abroad, with
community providers and academic specialists collaborating to respond to an
increasingly diverse range of chronic health issues.”