Hepatitis C treatment for difficult to access populations: can telementoring (as distinct from telemedicine) help?

Mohsen, Waled; Chan, Patrick; Whelan, Michelle; Glass, Ann; Mouton, Marlize; Young, Ernest Boyen; Tran, Quyen Thanh; Arora, Sanjeev; Davison, Scott A.; Lama, Tenzin; Cobrador, Cherry; Levy, Miriam

doi:10.1111/imj.14072

Cited by 27 publications

(39 citation statements)

References 20 publications

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“…In terms of direct patient outcome measures, three studies examined the rate of sustained virologic response among individuals treated for hepatitis C. While two articles found that SVR was similar among patients who sought care from EELM trainees and experts 16,62 -an indication of project success-another found that SVR did not differ between those seeing providers who received EELM training versus did not receive EELM training. 18 In a separate study looking at the effect of EELM on diabetes care, 65 the authors found positive results that training led to reductions in patient mean HbA1c values within practitioner panels, a result not found in a comparison group.…”

Section: Discussionmentioning

confidence: 99%

“…Arora and colleagues 16 compared sustained virologic response (SVR) between patients at training versus trainee sites and found no difference (p > 0.05), indicating trainees (generalists) performed at a level comparable to trainers (specialists). Similarly, Mohsen and colleagues 62 compared 100 patients of providers who participated in an EELM to 100 patients who received care in a tertiary liver clinic (TLC). Initiation of direct-acting antiviral therapy was similar between groups (EELM, 78%; TLC, 81%), as was completion of treatment (EELM, 89%; TLC, 86%) and-to a lesser Figure 2 Publications by topic, year, and outcome classification.…”

Section: Patient-related Outcomesmentioning

confidence: 99%

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Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

et al. 2019

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BACKGROUND: Extension for Community Health care Outcomes (ECHO) and related models of medical teleeducation are rapidly expanding; however, their effectiveness remains unclear. This systematic review examines the effectiveness of ECHO and ECHO-like medical teleeducation models of healthcare delivery in terms of improved provider-and patient-related outcomes. METHODS: We searched English-language studies in PubMed, Embase, and PsycINFO databases from 1 January 2007 to 1 December 2018 as well as bibliography review. Two reviewers independently screened citations for peer-reviewed publications reporting provider-and/ or patient-related outcomes of technology-enabled collaborative learning models that satisfied six criteria of the ECHO framework. Reviewers then independently abstracted data, assessed study quality, and rated strength of evidence (SOE) based on Cochrane GRADE criteria. RESULTS: Data from 52 peer-reviewed articles were included. Forty-three reported provider-related outcomes; 15 reported patient-related outcomes. Studies on provider-related outcomes suggested favorable results across three domains: satisfaction, increased knowledge, and increased clinical confidence. However, SOE was low, relying primarily on self-reports and surveys with low response rates. One randomized trial has been conducted. For patient-related outcomes, 11 of 15 studies incorporated a comparison group; none involved randomization. Four studies reported care outcomes, while 11 reported changes in care processes. Evidence suggested effectiveness at improving outcomes for patients with hepatitis C, chronic pain, dementia, and type 2 diabetes. Evidence is generally low-quality, retrospective, non-experimental, and subject to social desirability bias and low survey response rates. DISCUSSION: The number of studies examining ECHO and ECHO-like models of medical tele-education has been modest compared with the scope and scale of implementation throughout the USA and internationally. Given the potential of ECHO to broaden access to healthcare in rural, remote, and underserved communities, more studies are needed to evaluate effectiveness. This need for evidence follows similar patterns to other service delivery models in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Patient-related Outcomesmentioning

confidence: 99%

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

et al. 2019

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“…Some evidence suggests that telementoring can play a useful role in this area, enabling GPs ready access to specialist support, for example via Project Echo. 14 Other potential barriers to treatment include the likelihood that clinicians are managing several competing priorities where the patient is medically unwell or has comorbid medical conditions; 4% of patients in this study had a concurrent diagnosis of hepatocellular carcinoma (4%) or died (5%) shortly after their HCV notification. This study found another reason for not prescribing antiviral treatment included that 18% of patients were HCV RNAnegative, a rate in line with published literature 22 , and in this setting treatment is not indicated.…”

Section: Discussionmentioning

confidence: 98%

“…12,13 Significant investment has been made to educate and support Australian GPs to treat HCV. A number of resources have been developed to facilitate community-based treatment, for example Project Echo, which is a telementoring, group video conferencing tool used by Liverpool Hospital to link specialist hubs and primary care providers 14 ; however much more could be done to maintain the high rate of DAA uptake in Australia.…”

Section: Introductionmentioning

confidence: 99%

Public Health Unit notifications of hepatitis C and their follow-up in South Western Sydney, Australia

O'Brien¹,

Whelan²,

Lama³

et al. 2021

Public Health Res Pract.

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• Less than half of patients newly diagnosed with hepatitis C virus (HCV) in South Western Sydney, Australia, who are eligible for antiviral treatment received such treatment in the 12 months after diagnosis • Most general practitioners referred new patients with HCV to specialists, rather than starting patients on treatment themselves. A significant portion of HCV notifications did not receive adequate follow-up • New Public Health Unit notifications of HCV represent a clear target for investment, to improve continuity of care in the quest towards HCV elimination

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“…Programs like Project ECHO (Extension for Community Healthcare Outcomes) provide tele-educating and tele-proctoring. 32 Mobile applications such as the Accreditation Council for Graduate Medical Education (ACGME) case log (https://apps.acgme.org/ connect/login), MedHub (http://www.medhub.com), and SIMPL (http://www.procedurallearning.org/simpl), that have facilitated logging of duty hours, evaluations, cases, and assessments of resident performance, illustrate some examples of how information technology can be adapted to facilitate the workflow of surgical trainees and faculty and improve engagement and wellbeing.…”

Section: Process Improvementmentioning

confidence: 99%

The Value of the Surgeon Informatician

Zhao

Forsythe

Langerman

et al. 2020

Journal of Surgical Research

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Clinical informatics is an interdisciplinary specialty that leverages big data, health information technologies, and the science of biomedical informatics within clinical environments to improve quality and outcomes in the increasingly complex and often siloed health care systems. Core competencies of clinical informatics primarily focus on clinical decision making and care process improvement, health information systems, and leadership and change management. Although the broad relevance of clinical informatics is apparent, this review focuses on its application and pertinence to the discipline of surgery, which is less well defined. In doing so, we hope to highlight the importance of the surgeon informatician. Topics covered include electronic health records, clinical decision support systems, computerized order entry, data analytics, clinical documentation, information architectures, implementation science, quality improvement, simulation, education, and telemedicine. The formal pathway for surgeons to become clinical informaticians is also discussed.

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Hepatitis C treatment for difficult to access populations: can telementoring (as distinct from telemedicine) help?

Abstract: Project ECHO® is an effective model to support primary healthcare providers treating HCV in DTAPs with similar rates of treatment uptake and SVR compared to patients in TLCs This article is protected by copyright. All rights reserved.

Cited by 27 publications

References 20 publications

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

Public Health Unit notifications of hepatitis C and their follow-up in South Western Sydney, Australia

The Value of the Surgeon Informatician

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