Scroll through our quick slideshow to see how 3 recently published studies highlight the need for a telementoring program in HCV care.
The Extension for Community Healthcare Outcomes (Project ECHO) helps primary care providers (PCPs) and other community practitioners deliver best-practice care to complex patients in underserved populations. Through group video conferencing, specialists provide guidance and advice in discussions of de-identified, case-based presentations. Project ECHO was first developed in New Mexico as a way to extend best-practice hepatitis C virus (HCV) care to rural and prison populations. In this slide set, we review 3 recently published studies that demonstrate how Project ECHO:
While HCV is curable, treatment of difficult to access populations (DTAPs) presents unique challenges due to social isolation, limited resources, and other factors. In this study, investigators sought to determine whether weekly Project ECHO group video conferences, introduced in a hospital in Sydney, Australia, would support PCPs treating these patients. The “hub” of the conference at the hospital included a hepatologist, gastroenterology advanced trainee, clinic nurse consultant, pharmacist, administrative assistant, and a social worker, while the “spokes” were community healthcare practitioners who presented deidentified HCV cases during the meeting. For each patient, the hub and spoke agreed on a final management plan that was documented in a letter. Outcomes for 100 consecutive patients were compared with those for patients treated in a tertiary liver clinic.
HCV Treatment for Difficult to Access Populations: Telementoring. Authors of the study sought to determine whether Project ECHO could support PCPs who are treating DTAPs with HCV.
“Hub-and-Spoke” Approach to Telementoring. Weekly Project ECHO group video conferences were held based on the "hub and spoke" model where clinical and laboratory information, psychosocial elements, and treatment outcomes including SVR data were recorded in 100 patients. The recordings were then retrospectively compared to 100 consecutive tertiary liver clinic patients
Project ECHO Outcomes Match those from Tertiary Clinic. DAA treatment was initiated in 78/100 Project ECHO patients vs 81/100 patients in the tertiary liver clinic cohort. Treatment completion, cure rates, and loss to follow-up rates were similar in both Project ECHO and tertiary liver clinic cohort despite challenges in DTAP population that might be expected to produce higher rates of non-compliance and loss to follow-up.
Since the initially reported experience of Project ECHO improving care of HCV patients in rural areas and prisons, other participating centers have shared their experience. One of the most recent reports comes from a pilot study in Ireland that focused on evaluating the feasibility of “hub and spoke” video telementoring in the care of HCV-infected people who inject drugs (PWID).
Project ECHO Telementoring: European Pilot. Due to the lack of European community providers receiving proper training in the management of HCV patients, authors conducted a 6-month pilot study to evaluate the feasibility, acceptability, and implementation of Project ECHO in Ireland.
Project ECHO Study Focused on PWID. Authors focused on PWID receiving care in opiate substitution treatment centers and recruited state-employed doctors and nurses who were caring for a large number of HCV-infected PWID. The video conferences consisted of case-based discussions with the "hub" at the university teaching hospital and the "spokes" at community-based facilities that were not currently providing DAA treatment.
Project ECHO Proved Effective HCV Treatment for PWID. Patients and practitioners alike benefited from the intervention, which included 23 patient case discussions in total. Results of the pilot project suggest that Project ECHO can help address a significant unmet need specifically in the care of HCV-infected PWID.
While clinical outcomes of Project ECHO are impressive, there are few published data showing the economic impact of the model in the care of HCV-infected individuals. In this analysis, investigators calculated quality-adjusted life years (QALYs), budgetary impact, and other parameters in a model of simulated disease progression.
Expanding Access to HCV Care: Is Primary Care Cost-Effective? Authors of the study sought to assess the cost-effectiveness of HCV infection diagnosis and treatment in a primary care patient panel with and without the implementation of Project ECHO.
ECHO Impact on Costs, Quality of Life. Using the Markov model to simulate disease progression, QoL, and life expectancy in HCV patients and the general population, authors compared corresponding increases in survival, QALYs, costs, and budget impact for ECHO and non-ECHO HCV patients. Authors found that Project ECHO increases costs and QALYs with the incremental cost-effectiveness ratio being $10 351 per QALY.
Project ECHO Proves Cost-Effective in HCV Treatment. Results of the analysis suggest Project ECHO is very likely a cost-effective intervention, though high budgetary costs of investment suggest that an incremental rollout of the program would be ideal.
1. Hajarizadeh B, Grebely J, McManus H, et al. Chronic hepatitis C burden and care cascade in Australia in the era of interferon-based treatment. J Gastroenterol Hepatol. 2017;32:229-36.
2. Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364:2199-2207.