Title
Outcomes of community-based hepatitis C treatment by general practitioners and nurses in Australia via remote specialist consultation.
Link to article in PubMed
Author(s)
Haridy, James
Nicoll, Amanda
Muller, Kate
Wilson, Mark
Wigg, Alan
Ramachandran, Jeyamani
Nelson, Renjy
Bloom, Stephen
Sasadeusz, Joseph
Watkinson, Sally
Colman, Anton
Altus, Rosalie
Tilley, Emma
Stewart, Jeffrey
Hebbard, Geoff
Liew, Danny
Tse, Edmund
Abstract
BACKGROUND & AIMS: A unique model of care was adopted in Australia following introduction of universal subsidised direct-acting antiviral (DAA) access in 2016 in order to encourage rapid scale-up of treatment. Community-based medical practitioners and integrated hepatitis nurses initiated DAA treatment with remote hepatitis specialist approval of the planned treatment without physical review. We aimed to evaluate outcomes of community-based treatment of hepatitis C (HCV) through this remote consultation process in the first 12 months of this model of care. METHODS: A retrospective chart review of patients undergoing community-based HCV treatment from general practitioners and integrated hepatitis nurse consultants through the remote consultation model in three state jurisdictions in Australia from 1 March 2016 to 28 February 2017. RESULTS: SVR12 was confirmed in 383/588 (65.1%) subjects intended for treatment with a median follow-up time of 12 months (IQR 9-14 months). The SVR12 test was not performed in 159/588 (27.0%) and 307/588 (52.2%) did not have liver biochemistry rechecked following treatment. Subjects who completed follow-up exhibited high SVR12 rates (383/392,97.7%). Nurse-led treatment was associated with higher confirmation of SVR12 (73.7% v 62.4%, p = 0.01) and liver biochemistry testing post treatment (57.5% v 45.0%, p = 0.01). CONCLUSIONS: Community-based management of HCV through remote specialist consultation may be an effective model of care. Failure to check SVR12, recheck liver biochemistry and appropriate surveillance in patients with cirrhosis may emerge as significant issues requiring further support, education and refinement of the model to maximise effectiveness of future elimination efforts. This article is protected by copyright. All rights reserved.
Publication information
Intern Med J . 2021 Nov;51(11):1927-1934. doi: 10.1111/imj.15037. Epub 2021 Oct 28.
Date Issued
2020-09-06
Type
Journal Article
Journal Title
Internal medicine journal
Permanent link to this record
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