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.
Background: Parenteral nutrition (PN) is important to maintain adequate nutrition in patients who have a non-functioning gastrointestinal tract. Our aim was to characterise patients receiving PN initiated in the intensive care unit (ICU) or the general wards. Methods: Data from patients who received PN in two Australian hospital sites within a single health service between June and December 2016 (inclusive) was retrospectively collected. Demographics, cause for admission, indication and duration, and complications of PN were recorded. The latter included time to PN commencement, refeeding hypophosphataemia, biochemical liver dysfunction, hypoglycaemia and line sepsis. Results: Sixty-one patients received PN during this period. There was no delay between referral and commencing PN in ICU whilst seven (21.2%) ward patients were delayed by an average of 2.0 days (p ¼ 0.01). Ward patients averaged 8.1 days of negligible oral intake compared with 4.3 days in ICU (p ¼ 0.002). Complications were recorded in 19 (67.9%) ICU PN patients and 13 (39.4%) ward PN patients (p ¼ 0.04). Refeeding hypophosphataemia was detected in three (9.1%) ward patients and six (21.4%) in ICU. There were eight (24.2%) cases of liver biochemical abnormality post commencing PN on the ward compared with 14 (50%) in ICU. There was no difference in hospital length of stay or survival between the groups.
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