An eConsult service that treats people with hepatitis C virus (HCV) in a primary care clinic saw cure rates similar to those of independent primary care, according to findings published in the Journal of Viral Hepatitis.
“This study demonstrates that the implementation of an electronic consultation system aimed to support primary care physicians to treat HCV without requiring specialty involvement in care is an effective intervention to cure HCV within a large urban safety net health system,” wrote Jacey Nishiguchi, PharmD, of the San Francisco Department of Public Health, and colleagues.
The San Francisco Health Network is a safety net health care system, meaning that people can receive medical care regardless of their ability to pay for it. The network provides health care to 63,000 people with low incomes and people experiencing homelessness.
A dearth of specialists and limited knowledge about treating HCV among primary care providers is known to limit access to therapy. Set up in 2016, the eConsult system allows primary care physicians in the San Francisco Health Network to seek recommendations about individual treatment plans from liver disease specialists and pharmacists experienced in treating hepatitis C without requiring patients to visit a separate setting.
“This intervention aimed to address these barriers by providing the most up to date and evidence-based recommendations to primary care physicians without the need for a specialist,” wrote the researchers.
An earlier study found that the eConsult system tripled the number of individuals treated for hepatitis C in a primary care setting and that the number of primary care clinics providing HCV care rose from five to 12 in three years. Nishiguchi and colleagues examined the impact of the eConsult service in treating and curing HCV.
The researchers analyzed data from electronic medical records for all individuals who received antiviral therapy for HCV through 10 primary care clinics between January 2017 and August 2019. They compared how many people achieved a sustained virological response (SVR) through the eConsult service versus those who received primary care exclusive of an eConsult. SVR, or continued undetectable viral load 12 weeks after completing treatment, is considered a cure. The final study population included 242 people in the eConsult group and 214 people in the non-eConsult group.
Primary care physicians most often sought an eConsult to request advice about treatment plans. Some 20% sought to corroborate a treatment plan they were already considering; in almost all of these instances, treatment plans were in line with specialists’ recommendations.
SVR rates were similar in both the eConsult and non-eConsult groups, which the researchers attributed to highly effective antiviral therapy. More than 90% of participants were cured.
“This suggests the clinical recommendations provided through the eConsult to providers who requested assistance in HCV treatment resulted in similar cure rates as providers who chose to treat independently,” wrote the researchers.
Click here to read the study abstract in the Journal of Viral Hepatitis.
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