Outcomes of Hepatitis C Treatment by Primary Care Providers

By Sanjeev Arora, K. Thornton, G. Murata, Paulina Deming, S. Kalishman, Denise M. Dion, B. Parish, T. Burke, Wesley Pak, J. Dunkelberg and 5 more. New England Journal of Medicine, 2011

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Background The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for complex health problems such as hepatitis C virus (HCV) infection for underserved populations. Using videoconferencing technology, ECHO trains primary care providers to treat complex diseases. Methods A prospective cohort study compared treatment of HCV at the University of New Mexico (UNM) HCV clinic to treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 treatment naive patients with chronic HCV were enrolled. The primary end point was a sustained viral response (SVR). Results The rate of SVR was 57.5% (84/146) for patients treated at UNM and 58.2% (152 /261) at ECHO sites (P=0.89); difference between SVR rates 0.7% (95% CI -9.2%, 10.7%). In genotype 1 infection the SVR rate was 45.8% (38 /83) at UNM and 49.7% (73 /147) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the UNM HCV clinic cohort and 6.9% of the ECHO cohort. Conclusions This study demonstrates that the ECHO model is an effective way to treat HCV in underserved communities. Implementation of this model would allow other states and nations to treat more patients with HCV.

Subfields: Endocrinology, Diabetes and Metabolism, General Health Professions, Hepatology

View Paper: https://www.semanticscholar.org/paper/022651553166f880734e111036357414c816efe2

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