Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

[Guest guest]

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article

NEW ENGLAND JOURNAL OF MEDICINE

Original Article

Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Sanjeev Arora, M.D., Karla Thornton, M.D., Glen Murata, M.D., ina Deming,

Pharm.D., Summers Kalishman, Ph.D., Dion, Ph.D., Parish, M.D.,

Burke, B.S., Wesley Pak, M.B.A., Dunkelberg, M.D., Kistin,

M.D., Brown, M.A., Jenkusky, M.D., Miriam Komaromy, M.D., and

Clifford Qualls, Ph.D.

June 1, 2011 (10.1056/NEJMoa1009370)

The Extension for Community Healthcare Outcomes (ECHO) model was developed by

the University of New Mexico (UNM) Health Sciences Center as a platform for both

delivery of services and outcomes research.1,2 The objectives of the ECHO

program are to improve the access of minorities and other underserved

populations to best-practice care for hepatitis C virus (HCV) infection, to

determine the safety and efficacy of treatment for HCV infection based on the

ECHO model in rural communities, and to compare the effectiveness of the ECHO

model with that of university-based clinic treatment. The ECHO program increases

the accessibility of populations outside urban areas to the specialized medical

resources of academic medical centers.

An estimated 170 million patients worldwide have chronic HCV infection; 3.2

million of these patients live in the United States.3,4 Many patients were

infected in the 1970s and 1980s, leading to a rising tide of cirrhosis and

hepatocellular carcinoma.5 Chronic HCV infection accounts for 10,000 deaths each

year in the United States and is the leading reason for liver

transplantation.6,7

Fortunately, treatment for HCV is available and cost-effective; it cures 45% of

patients with HCV genotype 1 infection and 75% of patients with HCV genotype 2

or genotype 3 infection.8-11 A sustained virologic response permanently halts

the progression of liver disease, reverses fibrosis in many patients, and

reduces the risk of hepatocellular carcinoma. However, the treatment is complex.

Pegylated interferon (peginterferon) and ribavirin are associated with serious

side effects that require aggressive management by multidisciplinary

experts.9-11

Despite advances in treatment and remarkable improvements in cure rates, very

few persons with chronic HCV infection are receiving treatment. The total number

of prescriptions for HCV antiviral medications declined by 34% between 2002 and

2007. If this trend continues, it is estimated that treatment will prevent only

14.5% of potential liver-related deaths caused by HCV infection between 2002 and

2030.12 Members of racial and ethnic minorities and older patients are less

likely than other patients to receive needed care.13-16

The reasons for the inadequacy of and insufficient access to treatment for HCV

infection are complex and not completely understood. Historically, few primary

care clinicians have offered treatment for HCV infection in rural areas and

prisons, owing to a lack of training.17 In 2004, patients from rural areas had

to wait up to 6 months for an appointment at the UNM HCV clinic and had to

travel up to 250 miles. A typical patient with HCV genotype 1 infection would

have to make an average of 18 trips during the course of treatment. Major

barriers to care also exist among prison inmates. According to data from the

Department of Corrections, 40% of the 6000 inmates in the New Mexico Department

of Corrections are infected with HCV. As of 2003, not a single patient in the

correctional system had received treatment for HCV infection.

Lack of access to specialty care services at community-based health centers is a

major problem, particularly for uninsured patients.18,19 Community-based health

centers are often the most culturally appropriate and accessible choices for

care, particularly in rural areas, and providers at these centers can establish

trust through ongoing relationships with patients. Therefore, these centers can

be ideal places to provide complex care for HCV infection — if they have access

to the needed expertise.

FULL TEXT AT:

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article

[Guest guest]

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article

NEW ENGLAND JOURNAL OF MEDICINE

Original Article

Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Sanjeev Arora, M.D., Karla Thornton, M.D., Glen Murata, M.D., ina Deming,

Pharm.D., Summers Kalishman, Ph.D., Dion, Ph.D., Parish, M.D.,

Burke, B.S., Wesley Pak, M.B.A., Dunkelberg, M.D., Kistin,

M.D., Brown, M.A., Jenkusky, M.D., Miriam Komaromy, M.D., and

Clifford Qualls, Ph.D.

June 1, 2011 (10.1056/NEJMoa1009370)

The Extension for Community Healthcare Outcomes (ECHO) model was developed by

the University of New Mexico (UNM) Health Sciences Center as a platform for both

delivery of services and outcomes research.1,2 The objectives of the ECHO

program are to improve the access of minorities and other underserved

populations to best-practice care for hepatitis C virus (HCV) infection, to

determine the safety and efficacy of treatment for HCV infection based on the

ECHO model in rural communities, and to compare the effectiveness of the ECHO

model with that of university-based clinic treatment. The ECHO program increases

the accessibility of populations outside urban areas to the specialized medical

resources of academic medical centers.

An estimated 170 million patients worldwide have chronic HCV infection; 3.2

million of these patients live in the United States.3,4 Many patients were

infected in the 1970s and 1980s, leading to a rising tide of cirrhosis and

hepatocellular carcinoma.5 Chronic HCV infection accounts for 10,000 deaths each

year in the United States and is the leading reason for liver

transplantation.6,7

Fortunately, treatment for HCV is available and cost-effective; it cures 45% of

patients with HCV genotype 1 infection and 75% of patients with HCV genotype 2

or genotype 3 infection.8-11 A sustained virologic response permanently halts

the progression of liver disease, reverses fibrosis in many patients, and

reduces the risk of hepatocellular carcinoma. However, the treatment is complex.

Pegylated interferon (peginterferon) and ribavirin are associated with serious

side effects that require aggressive management by multidisciplinary

experts.9-11

Despite advances in treatment and remarkable improvements in cure rates, very

few persons with chronic HCV infection are receiving treatment. The total number

of prescriptions for HCV antiviral medications declined by 34% between 2002 and

2007. If this trend continues, it is estimated that treatment will prevent only

14.5% of potential liver-related deaths caused by HCV infection between 2002 and

2030.12 Members of racial and ethnic minorities and older patients are less

likely than other patients to receive needed care.13-16

The reasons for the inadequacy of and insufficient access to treatment for HCV

infection are complex and not completely understood. Historically, few primary

care clinicians have offered treatment for HCV infection in rural areas and

prisons, owing to a lack of training.17 In 2004, patients from rural areas had

to wait up to 6 months for an appointment at the UNM HCV clinic and had to

travel up to 250 miles. A typical patient with HCV genotype 1 infection would

have to make an average of 18 trips during the course of treatment. Major

barriers to care also exist among prison inmates. According to data from the

Department of Corrections, 40% of the 6000 inmates in the New Mexico Department

of Corrections are infected with HCV. As of 2003, not a single patient in the

correctional system had received treatment for HCV infection.

Lack of access to specialty care services at community-based health centers is a

major problem, particularly for uninsured patients.18,19 Community-based health

centers are often the most culturally appropriate and accessible choices for

care, particularly in rural areas, and providers at these centers can establish

trust through ongoing relationships with patients. Therefore, these centers can

be ideal places to provide complex care for HCV infection — if they have access

to the needed expertise.

FULL TEXT AT:

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article

[Guest guest]

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article

NEW ENGLAND JOURNAL OF MEDICINE

Original Article

Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Sanjeev Arora, M.D., Karla Thornton, M.D., Glen Murata, M.D., ina Deming,

Pharm.D., Summers Kalishman, Ph.D., Dion, Ph.D., Parish, M.D.,

Burke, B.S., Wesley Pak, M.B.A., Dunkelberg, M.D., Kistin,

M.D., Brown, M.A., Jenkusky, M.D., Miriam Komaromy, M.D., and

Clifford Qualls, Ph.D.

June 1, 2011 (10.1056/NEJMoa1009370)

The Extension for Community Healthcare Outcomes (ECHO) model was developed by

the University of New Mexico (UNM) Health Sciences Center as a platform for both

delivery of services and outcomes research.1,2 The objectives of the ECHO

program are to improve the access of minorities and other underserved

populations to best-practice care for hepatitis C virus (HCV) infection, to

determine the safety and efficacy of treatment for HCV infection based on the

ECHO model in rural communities, and to compare the effectiveness of the ECHO

model with that of university-based clinic treatment. The ECHO program increases

the accessibility of populations outside urban areas to the specialized medical

resources of academic medical centers.

An estimated 170 million patients worldwide have chronic HCV infection; 3.2

million of these patients live in the United States.3,4 Many patients were

infected in the 1970s and 1980s, leading to a rising tide of cirrhosis and

hepatocellular carcinoma.5 Chronic HCV infection accounts for 10,000 deaths each

year in the United States and is the leading reason for liver

transplantation.6,7

Fortunately, treatment for HCV is available and cost-effective; it cures 45% of

patients with HCV genotype 1 infection and 75% of patients with HCV genotype 2

or genotype 3 infection.8-11 A sustained virologic response permanently halts

the progression of liver disease, reverses fibrosis in many patients, and

reduces the risk of hepatocellular carcinoma. However, the treatment is complex.

Pegylated interferon (peginterferon) and ribavirin are associated with serious

side effects that require aggressive management by multidisciplinary

experts.9-11

Despite advances in treatment and remarkable improvements in cure rates, very

few persons with chronic HCV infection are receiving treatment. The total number

of prescriptions for HCV antiviral medications declined by 34% between 2002 and

2007. If this trend continues, it is estimated that treatment will prevent only

14.5% of potential liver-related deaths caused by HCV infection between 2002 and

2030.12 Members of racial and ethnic minorities and older patients are less

likely than other patients to receive needed care.13-16

The reasons for the inadequacy of and insufficient access to treatment for HCV

infection are complex and not completely understood. Historically, few primary

care clinicians have offered treatment for HCV infection in rural areas and

prisons, owing to a lack of training.17 In 2004, patients from rural areas had

to wait up to 6 months for an appointment at the UNM HCV clinic and had to

travel up to 250 miles. A typical patient with HCV genotype 1 infection would

have to make an average of 18 trips during the course of treatment. Major

barriers to care also exist among prison inmates. According to data from the

Department of Corrections, 40% of the 6000 inmates in the New Mexico Department

of Corrections are infected with HCV. As of 2003, not a single patient in the

correctional system had received treatment for HCV infection.

Lack of access to specialty care services at community-based health centers is a

major problem, particularly for uninsured patients.18,19 Community-based health

centers are often the most culturally appropriate and accessible choices for

care, particularly in rural areas, and providers at these centers can establish

trust through ongoing relationships with patients. Therefore, these centers can

be ideal places to provide complex care for HCV infection — if they have access

to the needed expertise.

FULL TEXT AT:

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article

[Guest guest]

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article

NEW ENGLAND JOURNAL OF MEDICINE

Original Article

Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers

Sanjeev Arora, M.D., Karla Thornton, M.D., Glen Murata, M.D., ina Deming,

Pharm.D., Summers Kalishman, Ph.D., Dion, Ph.D., Parish, M.D.,

Burke, B.S., Wesley Pak, M.B.A., Dunkelberg, M.D., Kistin,

M.D., Brown, M.A., Jenkusky, M.D., Miriam Komaromy, M.D., and

Clifford Qualls, Ph.D.

June 1, 2011 (10.1056/NEJMoa1009370)

The Extension for Community Healthcare Outcomes (ECHO) model was developed by

the University of New Mexico (UNM) Health Sciences Center as a platform for both

delivery of services and outcomes research.1,2 The objectives of the ECHO

program are to improve the access of minorities and other underserved

populations to best-practice care for hepatitis C virus (HCV) infection, to

determine the safety and efficacy of treatment for HCV infection based on the

ECHO model in rural communities, and to compare the effectiveness of the ECHO

model with that of university-based clinic treatment. The ECHO program increases

the accessibility of populations outside urban areas to the specialized medical

resources of academic medical centers.

An estimated 170 million patients worldwide have chronic HCV infection; 3.2

million of these patients live in the United States.3,4 Many patients were

infected in the 1970s and 1980s, leading to a rising tide of cirrhosis and

hepatocellular carcinoma.5 Chronic HCV infection accounts for 10,000 deaths each

year in the United States and is the leading reason for liver

transplantation.6,7

Fortunately, treatment for HCV is available and cost-effective; it cures 45% of

patients with HCV genotype 1 infection and 75% of patients with HCV genotype 2

or genotype 3 infection.8-11 A sustained virologic response permanently halts

the progression of liver disease, reverses fibrosis in many patients, and

reduces the risk of hepatocellular carcinoma. However, the treatment is complex.

Pegylated interferon (peginterferon) and ribavirin are associated with serious

side effects that require aggressive management by multidisciplinary

experts.9-11

Despite advances in treatment and remarkable improvements in cure rates, very

few persons with chronic HCV infection are receiving treatment. The total number

of prescriptions for HCV antiviral medications declined by 34% between 2002 and

2007. If this trend continues, it is estimated that treatment will prevent only

14.5% of potential liver-related deaths caused by HCV infection between 2002 and

2030.12 Members of racial and ethnic minorities and older patients are less

likely than other patients to receive needed care.13-16

The reasons for the inadequacy of and insufficient access to treatment for HCV

infection are complex and not completely understood. Historically, few primary

care clinicians have offered treatment for HCV infection in rural areas and

prisons, owing to a lack of training.17 In 2004, patients from rural areas had

to wait up to 6 months for an appointment at the UNM HCV clinic and had to

travel up to 250 miles. A typical patient with HCV genotype 1 infection would

have to make an average of 18 trips during the course of treatment. Major

barriers to care also exist among prison inmates. According to data from the

Department of Corrections, 40% of the 6000 inmates in the New Mexico Department

of Corrections are infected with HCV. As of 2003, not a single patient in the

correctional system had received treatment for HCV infection.

Lack of access to specialty care services at community-based health centers is a

major problem, particularly for uninsured patients.18,19 Community-based health

centers are often the most culturally appropriate and accessible choices for

care, particularly in rural areas, and providers at these centers can establish

trust through ongoing relationships with patients. Therefore, these centers can

be ideal places to provide complex care for HCV infection — if they have access

to the needed expertise.

FULL TEXT AT:

http://www.nejm.org/doi/full/10.1056/NEJMoa1009370?query=TOC#t=article