A nurse-led, telehealth-driven hepatitis C management initiative in regional Victoria: Cascade of care from referral to cure

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.

Telemedicine in Patients Affected by Chronic Liver Disease: A Scoping Review of Clinical Outcomes and the Devices Evaluated

“…Eleven articles report on HCV treatment outcomes through telehealth (Table 1), including remote specialist consultation, educational videos, and the support of primary care providers (five video telemedicine cases, four remote specialist consultations through teleconferences, one telephone consultation, and one paper-based referral followed by a fax or verbal discussion) [10][11][12][13][14][15][16][17][18][19][20].…”

Carbon footprint of gastroenterology practice

“…Several studies have shown that virtual visits typically reduce carbon emissions by 40%-70%, while maintaining high quality of care. [9][10][11] Telemedicine reduces the carbon footprint due to reduced travel, but perhaps also because of reduced unnecessary testing. In addition, it may improve access to care for patients who live remotely or are less able to afford a visit in person.…”

Proper distance in the age of social distancing: Hepatitis C treatment, telehealth and questions of care and responsibility

“…In this article, we have examined how telehealth affects treatment relationships in hepatitis C, building on existing literature that focuses on patient experience and drawing on qualitative data from interviews with patients and practitioners during the COVID‐19 pandemic in Australia. Overall, the argument contributes novel insights into patient experiences of telehealth for hepatitis C, raising questions about, and adding complexity to, research that emphasises the positive effects of telehealth for patients (Bensted et al., 2021 ; Lepage et al., 2020 ; Rodrigues et al., 2021 ; Schulz et al., 2020 ) by focussing on its role in treatment relationships.…”

“…While studies have long shown the importance of a positive patient‐practitioner relationship in treatment outcomes and attitudes to health care among people living with hepatitis C (Körner, 2010 ; Zickmund et al., 2004 ), research on patient experiences of telehealth is limited, and is mainly quantitative in methods (Bensted et al., 2021 ; Lepage et al., 2020 ; Rodrigues et al., 2021 ; Schulz et al., 2017 , 2020 ). Few studies have explored in detail how telehealth has shaped health care for people with hepatitis C. This article explores, for the first time, the impact of telehealth on the relational ethics of health care for hepatitis C. As we will argue, the concept of proper distance shows how communications media/technologies affect relationships and, therefore, notions and practices of responsibility.…”