Hepatitis C Treatment by Primary Care Clinicians
By Louis Kuritzky, MD
Clinical Assistant Professor
University of Florida, Gainesville
Dr. Kuritzky is an advisor for Endo, Kowa, Pricara, and Takeda. This article originally appeared in the July 29, 2011, issue of Internal Medicine Alert. At that time it was peer reviewed by Gerald Roberts, MD, Assistant Clinical Professor of Medicine, Albert Einstein College of Medicine, New York, NY.
Dr. Roberts reports no financial relationship to this field of study.
Source: Arora S, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med2011;364:2199-2207.
In most communities in the united states, hepatitis c (HepC) treatment is provided by gastroenterologists. Because HepC is now the most common cause of end-stage liver disease, and unless trends reverse will continue to be so for the foreseeable future, it is important that identification of HepC infection be continued vigorously in the primary care community, since most at-risk persons see primary care clinicians as their point of initial contact with the health care system.
Treatment of HepC offers the opportunity for cure of the disease more than 50% of the time, although persons infected with HepC genotype I have a somewhat lower success rate. Ideally, treatment would be offered to as many infected persons as possible, yet limitations in specialist consultants who traditionally administer the treatment are an obstacle to access for some patients.
The ECHO program (Extension for Community Healthcare Outcomes) is intended to enhance opportunities for provision of health care to underserved populations through, for instance, video-conferencing technology that allows primary care clinicians to receive case-based education with specialist colleagues. Since 2003, ECHO has resulted in 800 HepC patients being treated by primary care clinicians. The primary outcome of this ECHO-based trial was sustained virologic response, which is defined as undetectable HepC RNA 6 months beyond the end of treatment. Encouragingly, analysis of outcomes for patients treated on-site at the University of New Mexico HepC clinic were essentially identical with those of patients treated at distant sites by clinicians guided though case-based video-conferencing. Hopefully, enlarging the spectrum of clinicians who can provide state-of-the-art care for HepC patients will become a goal for other sites that have the capacity for video-conferencing.