Novel Models of Hepatitis C Virus Care Delivery: Telemedicine, Project ECHO, and Integrative Care

Arora, Sanjeev; Thornton, Karla

doi:10.1002/cld.912

Cited by 12 publications

(11 citation statements)

References 10 publications

(10 reference statements)

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“…46 Nevertheless, several policy and care initiatives could be considered based on these findings. First, efforts to enhance telehealth coverage and outreach are needed for geographically isolated patients, which has been shown to improve care and survival for patients with HCV [47][48][49][50][51][52][53][54][55][56] and to improve access to transplantation for patients with end-stage liver disease. 57 Second, data on county-level mortality and distance to a liver transplant center could better inform decisions when opening new liver transplant center(s), a strategy that has been proposed in other countries, or at the minimum satellite clinics to provide liver care to those with the highest mortality rates.…”

Section: Discussionmentioning

confidence: 99%

County Differences in Liver Mortality in the United States: Impact of Sociodemographics, Disease Risk Factors, and Access to Care

2021

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BACKGROUND AND AIMS: Data have demonstrated state-wide variability in mortality rates from liver disease (cirrhosis þ hepatocellular carcinoma), but data are lacking at the local level (eg, county) to identify factors associated with variability in liver disease-related mortality and hotspots of liver disease mortality. METHODS: We used Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research data from 2009 to 2018 to calculate county-level, ageadjusted liver disease-related death rates. We fit multivariable linear regression models to adjust for county-level covariates related to demographics (ie, race and ethnicity), medical comorbidities (eg, obesity), access to care (eg, uninsured rate), and geographic (eg, distance to closest liver transplant center) variables. We used optimized hotspot analysis to identify clusters of liver disease mortality hotspots based on the final multivariable models. RESULTS: In multivariable models, 61% of the variability in among-county mortality was explained by county-level race/ethnicity, poverty, uninsured rates, distance to the closest transplant center, and local rates of obesity, diabetes, and alcohol use. Despite adjustment, significant within-state variability in county-level mortality rates was found. Of counties in the top fifth percentile (ie, highest mortality) of fully adjusted mortality, 60% were located in 3 states: Oklahoma, Texas, and New Mexico. Adjusted mortality rates were highly spatially correlated, representing 5 clusters: South Florida; Appalachia and the eastern part of the Midwest; Texas and Oklahoma; New Mexico, Arizona, California, and southern Oregon; and parts of Washington and Montana. CONCLUSIONS: Our data demonstrate significant intrastate differences in liver disease-related mortality, with more than 60% of the variability explained by patient demographics, clinical risk factors for liver disease, and access to specialty liver care.

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Section: Discussionmentioning

confidence: 99%

County Differences in Liver Mortality in the United States: Impact of Sociodemographics, Disease Risk Factors, and Access to Care

2021

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“…Coronavirus disease 2019 (COVID‐19) pandemic accelerated telehealth utilization [2020_Telehealth_Benchmark_Survey_Results.pdf (ctfassets.net); Accessed on March 3, 2021] and expanded its use to urban populations. Upon successful experience with the Extension for Community Healthcare Outcome (ECHO) project, 18 similar models have been adopted across the globe, not only for treatment of chronic liver diseases but also for multiple clinical conditions, enabling access to care for rural patients 19 …”

Section: Applying Telehealth In Diagnosis and Management Of Nafld/nashmentioning

confidence: 99%

“…Upon successful experience with the Extension for Community Healthcare Outcome (ECHO) project, 18 similar models have been adopted across the globe, not only for treatment of chronic liver diseases but also for multiple clinical conditions, enabling access to care for rural patients. 19 Studies to determine role of telehealth specifically for NAFLD/NASH patients remain few and far between. 16,17 But opportunities abound for the use of telehealth to improve diagnosis and management of fatty liver disease.…”

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confidence: 99%

Using Telehealth for Diagnosis and Management of Non‐Alcoholic Fatty Liver Disease

Moein

Arteaga

Sarkar

2022

Clinical Liver Disease

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“…The impact of the COVID-19 pandemic on hepatitis C screening and linkage to care since March 2020 is an area of active study, though current data suggests the ability to meet WHO targets will be negatively impacted ( 5 ). However, there may be opportunities for improved access in the era of telemedicine, and virtual care may provide better access of care to certain populations of patients where in-person visits prove difficult ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Barriers to hepatitis C diagnosis and treatment in the DAA era: Preliminary results of a community-based survey of primary care practitioners

Sirpal

Chandok

2022

CanLivJ

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Notwithstanding the groundbreaking achievement of hepatitis C curative treatment with direct acting antiviral therapies, Canada faces an uphill battle in reaching the 2030 goal of viral elimination set forth the by the World Health Organization, a goal made more difficult by the COVID-19 pandemic. There is limited understanding of the diagnostic and treatment barriers, and challenges in linkage to care in Canada, especially as it pertains to primary care providers in a community context. Therefore, in this article, the authors conducted a survey study to evaluate the following factors: primary care providers’ knowledge of specialist treatment options and the importance of screening and treatment; and patient factors, including transportation, linguistic barriers, and other socio-economic status indicators that impact the screening and management of hepatitis C. The results suggest that public health campaigns that protocolize and/or incentivize screening and referrals may provide solutions to addressing such barriers.

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Novel Models of Hepatitis C Virus Care Delivery: Telemedicine, Project ECHO, and Integrative Care

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/16-1-interview-arora an interview with the author http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/16-1-reading-schaefer a video presentation of this article

Cited by 12 publications

References 10 publications

County Differences in Liver Mortality in the United States: Impact of Sociodemographics, Disease Risk Factors, and Access to Care

County Differences in Liver Mortality in the United States: Impact of Sociodemographics, Disease Risk Factors, and Access to Care

Using Telehealth for Diagnosis and Management of Non‐Alcoholic Fatty Liver Disease

Barriers to hepatitis C diagnosis and treatment in the DAA era: Preliminary results of a community-based survey of primary care practitioners

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