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Havaj DJ, Adamcová-Selčanová S, Mesíková K, Vnenčáková J, Žilinčanová D, Kubánek N, Šulejová KK, Mesárošová Z, Šváč J, Lapuník R, Ďurajová V, Skladaný Ľ. Telemedicine in the tertiary liver unit: A feasibility study. Clin Exp Hepatol 2024; 10:261-270. [PMID: 40290531 PMCID: PMC12022612 DOI: 10.5114/ceh.2024.145492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/07/2024] [Indexed: 04/30/2025] Open
Abstract
Aim of the study Chronic liver disease is a global cause of morbidity and mortality. Slovakia has a high prevalence but an inadequate hepatology network. The COVID-19 pandemic catalysed telemedicine (TM) as a potential solution, which we aimed to investigate. Material and methods We conducted a retrospective cohort study to evaluate the feasibility and benefits of TM for liver cirrhosis and posttransplant patients, consisting of two phases, TM1 and TM2. The main outcomes were 1) cumulative endpoint of feasibility, uptake/acceptance, adherence (TM1), and fidelity (TM1, TM2), 2) the potential to reduce the length of hospital stay, avert unnecessary hospital admissions, and expedite the search/recall process in case of serious signals mediated by TM. Although not analysed in this study, we have recorded variables necessary for investigating associations of TM use with clinical outcomes and healthcare expenditure. Results The study included 95 patients. The adherence documented by the termination of monitoring at the designated time was higher in TM2 (81.7% vs. 58.3%). The proportion of patients terminated due to death or the physician's decision decreased (16.9% vs. 29.2%) and was based on their discretion, unrelated to any health complications (1.4% vs. 12.5%). The clinical impact was reflected in the hospitalization rate, particularly shortened hospitalization in 11.3%, averted/prevented hospital admissions in 14.1%, and accelerated rehospitalization in 11.3% in the subsequent phase with alert-based interventions. Conclusions This study showed that adherence to TM was high and integrating TM helps to reduce hospitalization rates. Despite the identified limitations, TM has the potential to improve the quality and substantially reduce the cost of care.
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Affiliation(s)
- Daniel J. Havaj
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Svetlana Adamcová-Selčanová
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Klaudia Mesíková
- Office of Biomedical Research, F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Janka Vnenčáková
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Daniela Žilinčanová
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Natália Kubánek
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Karolína K. Šulejová
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Zuzana Mesárošová
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Juraj Šváč
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Radovan Lapuník
- Department of Public Economics and Regional Development, Faculty of Economics, Matej Bel University in Banská Bystrica, Slovakia
| | - Viktória Ďurajová
- Office of Biomedical Research, F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Ľubomír Skladaný
- 2 Department of Internal Medicine of the Slovak Medical University Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology, and Liver Transplant), F. D. Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
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Torre P, Festa M, Sarcina T, Masarone M, Persico M. Elimination of HCV Infection: Recent Epidemiological Findings, Barriers, and Strategies for the Coming Years. Viruses 2024; 16:1792. [PMID: 39599906 PMCID: PMC11598908 DOI: 10.3390/v16111792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 11/04/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024] Open
Abstract
Hepatitis C is a disease for which in approximately 30 years we have gone from the discovery of the causative agent in 1989, to the introduction of direct-acting antiviral (DAAs) therapies starting from 2011, and to a proposal for its elimination in 2016, with some countries being on track for this goal. Elimination efforts, in the absence of a vaccine, rely on prevention measures and antiviral therapies. However, treatment rates have declined in recent years and are not considered adequate to achieve this goal at a global level. This poses a great epidemiological challenge, as HCV in many countries still causes a significant burden and most infected people are not yet diagnosed. Consequently, efforts are needed at different levels with common purposes: to facilitate access to screening and diagnosis and to improve linkage to care pathways. In this review, we discuss the latest epidemiological findings on HCV infection, the obstacles to its elimination, and strategies that are believed to be useful to overcome these obstacles but are applied unevenly across the world.
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Affiliation(s)
| | | | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Largo Città d’Ippocrate, 84131 Salerno, Italy; (P.T.); (M.F.); (T.S.); (M.M.)
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Rodrigues B, Parsons N, Haridy J, Bloom S, Day C, Haar G, Nicoll A, Sawhney R. A nurse-led, telehealth-driven hepatitis C management initiative in regional Victoria: Cascade of care from referral to cure. J Telemed Telecare 2024; 30:497-504. [PMID: 34142898 DOI: 10.1177/1357633x211024108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elimination of hepatitis C virus stands as an unresolved World Health Organization target, and is associated with complications including cirrhosis and hepatocellular carcinoma. Hepatitis C virus management has been revolutionised following the widespread availability of direct-acting antiviral agents in Australia since 2016; however, large proportions of the population remain untreated. Telehealth-based service delivery is an accessible and effective alternative, and we aimed to assess qualitative and clinical outcomes in a clinical nurse consultant-led regional telehealth model. METHODS A prospective cohort analysis of all patients referred to a Victorian regional hospital's hepatitis C virus telehealth clinic between 1 April 2017 and 10 June 2020 was conducted. Data were collated from outpatient and electronic medical records. RESULTS Fifty-five out of 71 referred patients were booked, with 44 patients (80%) attending at least one appointment. A history of alcohol use disorder and psychiatric comorbidity was seen in 25 (54%) and 24 (52%) patients, respectively. Twenty-one out of 24 (88%) eligible patients had direct-acting antiviral agent treatment and 14 out of 21 (67%) successfully completed the treatment. An average of 46.5 km, 54.6 min and $AUD30.70 was saved per patient for each visit. Observed benefits included: increased medical engagement, adherence to and completion of HCV treatment and cirrhosis monitoring. Telehealth-driven hepatocellular carcinoma surveillance was successful in the cirrhotic subgroup. CONCLUSION Clinical nurse consultant-led hepatitis C virus management via telehealth allows access to marginalised regional populations. Clinical outcomes were comparable to other cohorts with additional cost-benefit, efficiency gains and carbon footprint reduction amongst a previously unreported regional Victorian hepatitis C virus population.
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Affiliation(s)
| | - Nola Parsons
- Department of Gastroenterology, Eastern Health, Australia
| | - James Haridy
- Department of Gastroenterology, Eastern Health, Australia
| | - Stephen Bloom
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Caroline Day
- Department of Gastroenterology, Eastern Health, Australia
| | - Geoffrey Haar
- Department of Gastroenterology, Eastern Health, Australia
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Australia
- Eastern Health Clinical School, Monash University, Australia
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Loy DE, Kamis K, Kanatser R, Rowan SE. Barriers to Hepatitis C Treatment and Interest in Telemedicine-Based Care Among Clients of a Syringe Access Program. Open Forum Infect Dis 2024; 11:ofae088. [PMID: 38464492 PMCID: PMC10921388 DOI: 10.1093/ofid/ofae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Background Sharing equipment for injection drug use is the most common mode of hepatitis C virus (HCV) transmission in the United States, yet people who inject drugs (PWID) historically have low rates of HCV treatment. New strategies are needed to expand access to HCV treatment among PWID. Co-locating HCV treatment at syringe access programs (SAPs) reduces barriers to treatment, and telemedicine-based treatment programs could expand access further. Methods To evaluate interest in a co-localized or telemedicine-based program at an SAP in Denver, Colorado, we surveyed 171 SAP clients to understand barriers to HCV treatment and comfort with various appointment modalities. Results Eighty-nine of the surveyed SAP clients (52%), 50 of whom had not completed treatment, reported current or prior HCV infection. The most commonly cited reasons for not seeking HCV treatment were ongoing drug use, logistic barriers, and medical system barriers. Eighty-eight percent of clients with HCV reported that they would be more likely to get treatment if they were able to do so at the SAP, and the rate was higher among people who reported reluctance to seek medical care in general (98% vs 77%, P = .011). In-person appointments were preferred, though 77% of respondents were comfortable with a video appointment. However, only 60% of SAP clients reported having access to a phone, and fewer (48%) had access to video capability. Conclusions These findings suggest that telemedicine-based treatment at an SAP could improve access to HCV treatment, but successful implementation would require attention to barriers impacting clients' ability to participate in telemedicine appointments.
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Affiliation(s)
- Dorothy E Loy
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Kevin Kamis
- Public Health Institute at Denver Health, Division of HIV/STI/Viral Hepatitis, Denver, Colorado, USA
| | | | - Sarah E Rowan
- Public Health Institute at Denver Health, Division of HIV/STI/Viral Hepatitis, Denver, Colorado, USA
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado, USA
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Elder AJ, Alazawi H, Shafaq F, Ayyad A, Hazin R. Teleoncology: Novel Approaches for Improving Cancer Care in North America. Cureus 2023; 15:e43562. [PMID: 37719501 PMCID: PMC10502915 DOI: 10.7759/cureus.43562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Due to widespread healthcare workforce shortages, many patients living in remote and rural North America currently have reduced access to various medical specialists. These shortages, coupled with the aging North American population, highlight the need to transform contemporary healthcare delivery systems. The exchange of medical information via telecommunication technology, known as telemedicine, offers promising solutions to address the medical needs of an aging population and the increased demand for specialty medical services. This progressive movement has also improved access to quality health care by mitigating the current shortage of trained subspecialists. Minimizing the effects of these shortages is particularly urgent in the care of cancer patients, many of whom require regular follow-up and close monitoring. Cancer patients living in remote areas of North America have reduced access to specialized care and, thus, have unacceptably high mortality and morbidity rates. Teleoncology, or the use of telemedicine to provide oncology services remotely, has the ability to improve access to high-quality care and assist in alleviating the burden of some of the severe adverse events associated with cancer. In this review, the authors describe how recent advances in teleoncology can reduce healthcare disparities and improve future cancer care in North America.
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Affiliation(s)
- Adam J Elder
- Department of Medical Education, Wayne State University School of Medicine, Detroit, USA
| | - Hussein Alazawi
- Department of Medical Education, Michigan State University College of Osteopathic Medicine, East Lansing, USA
| | - Fareshta Shafaq
- Department of Medical Education, American University of the Caribbean, Cupecoy, SXM
| | - Adam Ayyad
- Department of Medical Education, Ross University School of Medicine, Bridgetown, BRB
| | - Ribhi Hazin
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, USA
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Wu T, Simonetto DA, Halamka JD, Shah VH. The digital transformation of hepatology: The patient is logged in. Hepatology 2022; 75:724-739. [PMID: 35028960 PMCID: PMC9531185 DOI: 10.1002/hep.32329] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022]
Abstract
The rise in innovative digital health technologies has led a paradigm shift in health care toward personalized, patient-centric medicine that is reaching beyond traditional brick-and-mortar facilities into patients' homes and everyday lives. Digital solutions can monitor and detect early changes in physiological data, predict disease progression and health-related outcomes based on individual risk factors, and manage disease intervention with a range of accessible telemedicine and mobile health options. In this review, we discuss the unique transformation underway in the care of patients with liver disease, specifically examining the digital transformation of diagnostics, prediction and clinical decision-making, and management. Additionally, we discuss the general considerations needed to confirm validity and oversight of new technologies, usability and acceptability of digital solutions, and equity and inclusivity of vulnerable populations.
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Affiliation(s)
- Tiffany Wu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas A. Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - John D. Halamka
- Mayo Clinic Platform, Mayo Clinic, Rochester, Minnesota, USA
| | - Vijay H. Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Background: Hepatitis C virus (HCV) is a global public health issue that can cause both acute and chronic liver diseases. There is a high risk of HCV burden, but limited access and cost remain a challenge for proper diagnosis and treatment. Leveraging eHealth technology may indicate a viable solution for the management of HCV patients. Objective: To review the literature regarding the role of eHealth, including telemedicine, in the management of HCV. Methods: Databases including PubMed, Google Scholar, Medline, Web of Science, and Science Direct were searched from 1 January 2008 to 30 June 2020 to identify different types of eHealth interventions used for the management of adult HCV patients. Our search also determined the role of telehealth for HCV patients in the current pandemic. Results: Four main categories emerged from this scoping review that includes improving treatment rates via utilizing telehealth services, satisfaction with the telehealth services, disease management, health promotion, and similarity between telehealth and traditional modalities. Conclusion: Current evidence suggests that telemedicine is a cost-effective and unique platform to improve patients’ access to quality services that curb the increasing burden of this silent killer in developing countries. This modality can certainly be utilized in the current crisis to manage care for HCV patients efficiently.
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Pappalardo M, Fanelli U, Chiné V, Neglia C, Gramegna A, Argentiero A, Esposito S. Telemedicine in Pediatric Infectious Diseases. CHILDREN-BASEL 2021; 8:children8040260. [PMID: 33800549 PMCID: PMC8066295 DOI: 10.3390/children8040260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Telemedicine is the remote practice of medicine through the use of information and communication technologies for the prevention, diagnosis, treatment and management of diseases. In this narrative review, we illustrate how telemedicine technologies are increasingly integrated into pediatric infectious disease programs with the aim of facilitating access to specialist care and reducing costs. There is widespread use of telemedicine for the management of acute and chronic infectious diseases, particularly in countries in which the majority of the population lives in rural areas, far from third-level hospital centers located in large urban centers. Obviously, telemedicine is also used in developed countries, and its importance has been further increased recently given the COVID-19 pandemic. It has many advantages for patients, such as saving time, money and working hours, and reducing cancelled appointments and delays, while there are also many advantages for doctors, allowing collaborations with specialists and continuous updating. Among the disadvantages are the limitation in carrying out an objective examination, which is particularly important for children under 2 years of age, and the need for cutting-edge technology and reliable connectivity. Telemedicine increasingly represents the future and the beginning of a new healthcare system that also will redefine medical care for the treatment of infectious diseases, both acute and chronic. However, the majority of the experience has involved adults, and its validation in pediatric care, as well as its application in real-life practices, are urgently needed.
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Affiliation(s)
- Marco Pappalardo
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Umberto Fanelli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Vincenzo Chiné
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Cosimo Neglia
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
- Correspondence: ; Tel.: +39-0521-704790
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Abstract
PURPOSE OF REVIEW Novel technologies, such as high-definition cameras, encryption software, electronic stethoscopes, microfluidic diagnostic systems, and widely available broadband Internet have expanded the potential for telemedicine. This narrative review presents current and future uses of telemedicine in the prevention, diagnosis, treatment, stewardship, and management of infectious disease. RECENT FINDINGS Beginning in the 1990s, early approaches to telemedicine in infectious disease focused largely on treatment of HIV/AIDS, hepatitis C, and tuberculosis. However, recent innovations allow for targeting of additional diseases and in increasingly remote settings. Telemedicine allows virtual visits between patients in the home and remote providers, permitting outpatient management of complex conditions, such as post-surgical site monitoring, and non-urgent infectious maladies, such as uncomplicated urinary tract infection. Remote provider education by videoconference and integrated clinical decision support tools create avenues to improve inpatient care, including antimicrobial stewardship. Technological strides from miniaturization of diagnostic tests to robotic telepresence physical exams improve access to infectious disease care in isolated and infrastructure-poor environments, from cargo ships to other resource-limited settings. Telemedicine in the field of infectious disease is rapidly expanding in clinical, technological, geographical, and human capacity. Recent innovations narrow gaps in access to care for populations traditionally underserved, stigmatized, isolated by remote geography, or lacking technological infrastructure. Current and future approaches will transform inpatient, outpatient, and remote care.
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Stotts MJ, Grischkan JA, Khungar V. Improving cirrhosis care: The potential for telemedicine and mobile health technologies. World J Gastroenterol 2019; 25:3849-3856. [PMID: 31413523 PMCID: PMC6689809 DOI: 10.3748/wjg.v25.i29.3849] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.
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Affiliation(s)
- Matthew Jonathon Stotts
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Justin Alexander Grischkan
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Vandana Khungar
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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Zuckerman A, Carver A, Chastain CA. Building a Hepatitis C Clinical Program: Strategies to Optimize Outcomes. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018; 10:431-446. [PMID: 30524209 PMCID: PMC6244618 DOI: 10.1007/s40506-018-0177-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW An increasing number of specialists and non-specialists are developing clinical programs to treat and cure hepatitis C virus (HCV). The goal of this paper is to evaluate and describe optimal strategies to improve outcomes related to HCV care delivery. RECENT FINDINGS Screening and diagnosis of HCV should be guided by established recommendations. Given the recognized disparity in HCV diagnosis and linkage to care, a multi-modal approach involving care coordination and technology resources should be used to improve patient engagement. Access to HCV treatment may be optimized through systematic documentation, prior authorization, and appeal processes. Treatment monitoring should emphasize medication adherence, side effect and drug interaction management, as well as elimination of practical barriers. Finally, post-treatment engagement to promote liver health and reduce the risk of complications or reinfection maximizes the benefit of HCV treatment. SUMMARY The landscape of HCV treatment has evolved from a specialist-driven model with few patients qualifying for treatment to an opportunity for non-specialists and other providers to provide curative therapies in most patients. Innovative practice models that employ a multidisciplinary approach will likely improve screening, diagnosis, engagement, and treatment outcomes.
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Affiliation(s)
- Autumn Zuckerman
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Alicia Carver
- Specialty Pharmacy Services, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Cody A. Chastain
- Division of Infectious Diseases, Vanderbilt University Medical Center, A2200 MCN, 1161 21st Avenue, Nashville, TN 37232-2605 USA
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Serper M, Volk ML. Current and Future Applications of Telemedicine to Optimize the Delivery of Care in Chronic Liver Disease. Clin Gastroenterol Hepatol 2018; 16:157-161.e8. [PMID: 29389489 PMCID: PMC6334286 DOI: 10.1016/j.cgh.2017.10.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marina Serper
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Department of Medicine, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Michael L. Volk
- Division of Gastroenterology and Transplantation Institute, Loma Linda University, Loma Linda, California
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Cooper CL, Hatashita H, Corsi DJ, Parmar P, Corrin R, Garber G. Direct-Acting Antiviral Therapy Outcomes in Canadian Chronic Hepatitis C Telemedicine Patients. Ann Hepatol 2017; 16:874-880. [PMID: 29055923 DOI: 10.5604/01.3001.0010.5277] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Many of the 300,000 HCV-infected Canadians live in under-served and remote areas without access to HCV healthcare specialists. Telemedicine (TM) and advances in HCV management can facilitate linkage of these marginalized patients to healthcare. MATERIALS AND METHODS A cohort database analysis was performed on patients followed at The Ottawa Hospital and Regional Viral Hepatitis Program between January 2012 and August 2016. We compared patient characteristics, fibrosis work-up and antiviral treatment outcomes in TM (n = 157) and non-TM (n = 1,130) patients (The Ottawa Hospital Viral Hepatitis Outpatient Clinic) residing in Eastern Ontario. RESULTS TM patients were more often infected with genotype 3 (25.9% vs. 16.4%), were more commonly Indigenous (7.0% vs. 2.2%) had a history of injection drug use (70.1% vs. 54.9%) and incarceration (46.5% vs 35.5%). Groups were comparable in age (48.9 years), gender (63.7% male) and cirrhotic stage (24.0%). 59.2% of TM patients underwent transient elastography during regional outreach blitzes compared to 61.8% of non-TM patients (p = 0.54). Overall, half as many TM patients initiated antiviral therapy as non-TM patients (27.4% vs. 53.8%, p < 0.001). The introduction of DAA regimens is bridging this gap (22.2% of TM patients vs. 34.3% of non-TM patients). SVR rates with interferon-free, DAA regimens were 94.7% and 94.8% in TM and non-TM groups (p = 0.99). CONCLUSION Our TM program engages and retains a population that faces many barriers to effective HCV treatment. TM patients initiated HCV therapy and achieved High SVR rates comparable to those obtained using traditional models of care.
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Affiliation(s)
- Curtis L Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Division of Infectious Diseases, Department of Medicine Ottawa Hospital Research Institute
| | - Holly Hatashita
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Parmvir Parmar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Raymond Corrin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary Garber
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Yoo ER, Perumpail RB, Cholankeril G, Jayasekera CR, Ahmed A. The Role of e-Health in Optimizing Task-Shifting in the Delivery of Antiviral Therapy for Chronic Hepatitis C. Telemed J E Health 2017; 23:870-873. [PMID: 28375820 DOI: 10.1089/tmj.2016.0189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Recently, we reported the successful application of task-shifting to improve the management of patients with chronic hepatitis C virus (HCV) infection receiving treatment with direct-acting antiviral (DAA) agents in underserved areas of California. We assessed the impact of e-health on task-shifting in our treatment model. METHODS In a retrospective analysis, we reviewed the impact of e-health on optimizing the delivery of DAA-based regimen to HCV-infected patients in outreach clinics in medically underserved areas of California. A nonphysician healthcare provider worked in close conjunction with a hepatologist to monitor the patients during the course of antiviral therapy. We exclusively used our institution-based, secured e-health portal as the means of communication with the local staff and patients in outreach clinics. RESULTS From January 2015 to June 2016, we treated over 100 HCV-infected patients with DAA-based regimens using the task-shifting model. During the study period, we did not experience any delay in the care of our patients undergoing treatment with DAA agents. Communication with the patient and staff using e-health was prompt, secured, and documented in electronic medical records. Due to the optimization of task-shifting by e-health and safety/tolerability of DAA, 95% patients did not need a follow-up clinic visit during the treatment. Return clinic visits during the treatment were unrelated to DAA use or associated with ribavirin-related anemia. In addition, we noted improvement in access and capacity of our outreach clinic. CONCLUSIONS We report a positive impact of e-health in optimizing task-shifting for DAA in HCV-infected patients in underserved outreach clinics. More importantly, a secondary improvement in access and capacity of our clinic was noted.
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Affiliation(s)
- Eric R Yoo
- 1 Department of Medicine, University of Illinois College of Medicine , Chicago, Illinois
| | - Ryan B Perumpail
- 2 Division of Gastroenterology and Hepatology, Stanford University School of Medicine , Stanford, California
| | - George Cholankeril
- 3 Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center , Memphis, Tennessee
| | - Channa R Jayasekera
- 2 Division of Gastroenterology and Hepatology, Stanford University School of Medicine , Stanford, California.,4 Center for Innovation in Global Health, Stanford University , Stanford, California
| | - Aijaz Ahmed
- 2 Division of Gastroenterology and Hepatology, Stanford University School of Medicine , Stanford, California
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Parmar P, Mackie D, Varghese S, Cooper C. Use of telemedicine technologies in the management of infectious diseases: a review. Clin Infect Dis 2014; 60:1084-94. [PMID: 25516192 DOI: 10.1093/cid/ciu1143] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Telemedicine technologies are rapidly being integrated into infectious diseases programs with the aim of increasing access to infectious diseases specialty care for isolated populations and reducing costs. We summarize the utility and effectiveness of telemedicine in the evaluation and treatment of infectious diseases patients. The use of telemedicine in the management of acute infectious diseases, chronic hepatitis C, human immunodeficiency virus, and active pulmonary tuberculosis is considered. We recapitulate and evaluate the advantages of telemedicine described in other studies, present challenges to adopting telemedicine, and identify future opportunities for the use of telemedicine within the realm of clinical infectious diseases.
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Affiliation(s)
| | - David Mackie
- Ottawa Hospital and Regional Viral Hepatitis Telemedicine Program
| | - Sunil Varghese
- Ottawa Hospital and Regional Viral Hepatitis Telemedicine Program
| | - Curtis Cooper
- Faculty of Medicine, University of Ottawa Ottawa Hospital and Regional Viral Hepatitis Telemedicine Program Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ontario, Canada
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Rongey C, Shen H, Hamilton N, Backus LI, Asch SM, Knight S. Impact of rural residence and health system structure on quality of liver care. PLoS One 2013; 8:e84826. [PMID: 24386420 PMCID: PMC3873451 DOI: 10.1371/journal.pone.0084826] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023] Open
Abstract
Background Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV) becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care. Methods The study used a national cohort of 151,965 Veterans Health Administration (VHA) patients with HCV starting in 2005 and followed to 2009. The VHA’s constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed. Results Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75) and rural (HR 0.96, CI 0.94-0.97) residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50) and rural residents (HR 1.06, CI 1.02-1.10) were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider. Conclusion Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.
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Affiliation(s)
- Catherine Rongey
- Department of Medicine, Veterans Affairs Medical Center and University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Hui Shen
- Department of Biostatics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
| | - Nathan Hamilton
- Department of Biostatics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
| | - Lisa I. Backus
- Department of Medicine, Veterans Affairs Medical Center, Palo Alto, California, United States of America
- Office of Public Health and Population Health, Department of Veterans Affairs, Washington, District of Columbia, United States of America
| | - Steve M. Asch
- Department of Medicine, Veterans Affairs Medical Center, Palo Alto, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Sara Knight
- Departments of Psychiatry and Urology, Veterans Affairs Medical Center, San Francisco, California, United States of America
- Office of Research and Development, Department of Veterans Affairs, Washington, District of Columbia, United States of America
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17
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Rossaro L, Torruellas C, Dhaliwal S, Botros J, Clark G, Li CS, Minoletti MM. Clinical outcomes of hepatitis C treated with pegylated interferon and ribavirin via telemedicine consultation in Northern California. Dig Dis Sci 2013; 58:3620-5. [PMID: 24154637 PMCID: PMC4591052 DOI: 10.1007/s10620-013-2810-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 07/15/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients in rural communities are less likely to receive treatment for their hepatitis C (HCV) infection. Telemedicine (TM) consultation can close the gap of access to specialists in remote and under-served areas. AIM To determine treatment response and side-effect profiles among HCV patients treated with pegylated interferon and ribavirin via TM consultation in different rural locations in Northern California compared with patients treated in traditional hepatology office visits. METHODS We performed a retrospective analysis of 80 HCV patients treated at different TM sites (TM, n=40) and at the University of California Davis Hepatology Clinic (HC, n=40) between 2006 and 2010, comparing baseline characteristics and clinical outcomes. RESULTS At baseline, response to therapy was similar for patients in both groups. Sustained virological response (SVR) was similar in both groups (TM: 55 vs. HC: 43%; p=0.36), and a higher proportion of patients treated via telemedicine completed treatment (TM: 78 vs. HC: 53%; p=0.03). TM patients had many more visits per week of therapy (TM: 0.61 vs. HC: 0.07; p<0.001). Neutropenia, GI side effects, fatigue, depression, weight loss, insomnia, and skin rash were similar in both groups. For HC patients incidence of anemia was significantly higher (53%) than for the TM group (25%; p=0.02). CONCLUSIONS The two groups had equivalent SVR. For the TM group therapy completion was superior and incidence of anemia was lower. This initial study suggests that, as a group, patients with HCV, can be safely and effectively treated via telemedicine.
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Nazareth S, Kontorinis N, Muwanwella N, Hamilton A, Leembruggen N, Cheng WS. Successful treatment of patients with hepatitis C in rural and remote Western Australia via telehealth. J Telemed Telecare 2013; 19:101-6. [DOI: 10.1258/jtt.2012.120612] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rural and remote patients at the Royal Perth Hospital were reviewed and treated for hepatitis C by a hepatologist and nurse practitioner using telehealth (videoconferencing). Over a four-year period, 50 patients were treated with pegylated interferon and ribavirin, and participated in a total of more than 500 telehealth sessions. Sustained virological response rates (SVRs) were compared to those in face-to-face (FTF) clinics to assess treatment outcomes. Treatment through telehealth was found to be non-inferior to FTF clinics. Telehealth patients with genotype 1 infection achieved a higher rate of SVR than those attending FTF clinics (73% versus 54%, respectively), although the difference was not significant. SVR rates for genotype 2 and 3 of 72% were similar in telehealth to FTF rates of 74%. A total of 35 telehealth patients completed a satisfaction questionnaire and most indicated that they were happy with the programme and would participate again in the future. The study confirmed that telehealth is an effective option for the treatment of hepatitis C in rural and remote areas.
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Affiliation(s)
- Saroja Nazareth
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia
| | - Nickolas Kontorinis
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia
| | - Niroshan Muwanwella
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia
| | - Alan Hamilton
- Western Australian Statewide Telehealth Service, Royal Perth Hospital, Perth, Australia
| | - Nadine Leembruggen
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia
| | - Wendy Sc Cheng
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia
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Dehghan Nayeri N, Asadi Noghabi AA, Molaee S. The Effect of Telephone Consultation on the Quality of Life of Patients Receiving Interferon Therapy: A Quasi-experimental Study. Telemed J E Health 2012; 18:459-63. [DOI: 10.1089/tmj.2011.0164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Imperial JC. Chronic hepatitis C in the state prison system: insights into the problems and possible solutions. Expert Rev Gastroenterol Hepatol 2010; 4:355-64. [PMID: 20528122 DOI: 10.1586/egh.10.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The prevalence of chronic hepatitis C virus (HCV) within the correctional system is estimated to be 10-20-times greater than that which is reported in the general population. High-risk behavioral patterns probably account for the greater estimates in this population. Recent observations of more than 780 patient-inmates infected with HCV within the California Department of Corrections suggest a very high prevalence of advanced fibrosis in this population. Observational studies performed in Texas have shown that the rates of chronic liver disease-related deaths have increased significantly between 1989 and 2003, especially among Hispanic patient-inmates. Viral hepatitis accounts for a significant number of these chronic liver disease-related deaths. Identification of high-risk patient-inmates infected with HCV, as well as appropriation of funds for their treatment, should result in a decreased rate of liver-related complications. This should translate into reduced morbidity and cost to correctional institutions, as well as to improved public health and safety.
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Affiliation(s)
- Joanne C Imperial
- Correctional Medicine Consultation Network, University of California, San Francisco, 1940 Bryant Street, San Francisco, CA 94110, USA.
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