Can videoconferencing improve outcomes for hep C patients who have used IV drugs?
by Larry Buhl
Thanks to a $7 million grant from the Patient-Centered Outcomes Research Institute (PCORI), the State University of New York (SUNY) will be testing to see whether video consultations with liver specialists can improve the recovery rate for drug users with the hepatitis C virus (HCV).
“By funding such patient-centered CER [comparative effectiveness research], PCORI seeks to build the evidence base that will help patients, clinicians, healthcare systems, and payers optimally detect and manage this challenging chronic condition,” Steve Clauser, PhD, MD and PCORI Program Director told A&U.
PCORI is an independent, non-profit organization authorized by Congress in 2010 to conduct evidence-based research to identify the most effective health care approaches.
Groundbreaking therapies are now available for the treatment of HCV, but if patients can’t adhere to the regimens, and if they don’t even make the appointments to see the specialists, they won’t be able to benefit from the meds. Adherence is an even bigger issue for those who inject drugs. It’s estimated that five million people in the U.S. are infected by HCV, as many as 70 percent classified as chronically infected. And patients who inject drugs are at a high risk of contracting and spreading the infection.
The SUNY project aims to provide a model to improve upon current approaches for treating patients with HCV who are also recovering from addiction, according to the study leader, Andrew Talal, MD, MPH, a professor of medicine and director of the Center for Clinical Care and Research in Liver Disease at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo.
“One big issue is that patients on methadone face stigma and usually don’t feel welcomed in conventional health care settings,” Talal told A&U.
The current standard of treatment for drug users with HCV involves a visit to a methadone clinic, followed by a referral to a liver specialist for continued care. But few patients follow through on those referrals and fewer still follow a prescribed care plan.
But because methadone is highly regulated, patients come to the clinic for it on a weekly basis, and many of these patients have untreated hepatitis C. If liver specialists were able to see them at the methadone clinics, the theory goes, hepatitis treatment would be much easier.
Unfortunately, these specialists have lots of patients to see and they aren’t fond of venturing from their domains.
“The good news is that technology has developed to the point where specialists can be brought in remotely, and don’t have to see patients at the center,” Talal said.
The five-year SUNY project will use a videoconference platform to connect a doctor and an addict who doesn’t want to be in a doctor’s office. The idea is that a video visit with a specialist arranged at the methadone clinic would improve patients’ level of trust, and boost patient adherence to a care management plan.
A small pilot project last year showed that HCV patients who use drugs can have a greater adherence through the telehealth model. At the European Liver Conference in Barcelona last April, Talal shared the results of a group of eighteen drug users with HCV who were getting treatment for their addiction at a methadone clinic in New York City. Those patients received HCV medication while participating in biweekly telemedicine conferences with Dr. Talal, who was 400 miles away, in Buffalo.
“Among the many positive findings was that methadone users with HCV do want to see a specialist to manage their care, but they prefer not to see that specialist in a traditional setting,” Talal said.
That project is being expanded to twelve methadone clinics throughout New York state, and will compare a standard regimen of in-person care with treatment by video visits.
Talal and his team will measure the rate of virus eradication twelve weeks after completing HCV treatment, as well as patient satisfaction, treatment completion rates and treatment adherence rates. Recruitment for more than 600 subjects began in February.
Talal added that, eventually, methadone clinics could diversify and offer more medical services. If that happens, they could be a patients’ primary care facility.
“If we show that this [telehealth] model is effective, then why not use it to treat HIV, or any chronic disease that requires the intervention of a specialist?” Talal said.
Telehealth, the general term of using videoconferencing and web-based applications to connect patients and doctors—and general practitioners to specialists—has shown promise in reducing costs and improving outcomes throughout the continuum of care. For hep C, Project ECHO, which stands for Extension for Community Healthcare Outcomes, has been helping rural doctors understand hepatitis better by linking them to hepatologists and gastroenterologists.
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.