An eHealth model of care for community treatment of hepatitis C: The - - PowerPoint PPT Presentation

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An eHealth model of care for community treatment of hepatitis C: The - - PowerPoint PPT Presentation

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Dr James Haridy MBBS B.Physio MPH Gastroenterology & Hepatology Fellow, PhD Candidate Royal Melbourne Hospital / University of Melbourne An eHealth model of care for community treatment of hepatitis C: The HealthElink study 230,000

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An eHealth model of care for community treatment of hepatitis C: The HealthElink study

Dr James Haridy MBBS B.Physio MPH

Gastroenterology & Hepatology Fellow, PhD Candidate Royal Melbourne Hospital / University of Melbourne

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230,000 Australians Infected1

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0% 20% 40% 60% 80% 100% 1990 1998 2001 2011 2016 7% 25% 45% 70% 95% SUSTAINED VIROLOGICAL RESPONSE YEAR

We are at an incredible point in history….

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Ref 2,3

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The first 12-months

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Why do we need GPs to prescribe this treatment? And what are the barriers in the current model of care?

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The current problems..

Patient Specialist GP Nurse @jamesharid y

  • Difficult to reach high-risk populations
  • Prisons
  • People Who Inject Drugs
  • Mental Health
  • Indigenous
  • Stigma
  • Cannot attend specialist / hospital
  • Rural/Remote
  • Simply do not turn up
  • Concerned about loss to followup
  • Potential for missing cirrhosis
  • Capacity and access
  • Cost
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The HealthElink system

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GP / Nurse / Specialist Portals Patient Portal

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  • Complex treatment algorithm
  • Multiple treatment plans based on hepatitis C type, fibrosis

assessment and medication interactions

  • Security
  • Ernst and Young engaged to advised on security, including

code review and penetration testing.

  • Corrs Chambers Westgarth engaged to provide advice on

health data privacy compliance.

  • Data storage on HIPAA compliant Amazon Web Servers

The HealthElink system

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The HealthElink study

Aim To determine the feasibility, efficacy and acceptability of an eHealth system in the community treatment of hepatitis C

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2014 2015 2016 2017 2018 2019

Timeline

Development

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HealthElink Study

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  • 16 users in total over two early versions
  • Median time for referral HealthElink 538 v 552 seconds
  • Correct treatment regimen prescribed in 12/12 (100%)

using HealthElink compared with 9/12 (75%) using current paper based form

  • 12/12 (100%) preferred use of the HealthElink system
  • 1. Usability study

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  • 2. The HealthElink Study

Prospective multicenter trial Target 500 non-specialist referrals Prison services in NT / SA

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  • Late 2018, purposive sampling of representative usage

groups

  • Users displaying both high and low activity on the

system to be interviewed in semi-structured interview

  • Explore acceptability and motivation behind uptake (or

non-uptake) of the system

  • 3. Qualitative study – planned in 2018

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  • Trial in other chronic diseases
  • Further funding to develop system further, enhance

compatibility

  • Mobile / app development to enhance patient

experience and interactivity

  • Refine based on user feedback

The future plan

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  • Hepatitis C now can be cured, but we still need to get

the cure out there

  • Deficiencies in the traditional model of care preclude

rapid and widespread implementation in primary care

  • An eHealth model of care offers a solution to overcome

many of the barriers to eradication

In Summary

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This research would not be possible without many others:

  • Dr Guru Iyngkaran
  • Dr Edmund Tse
  • Dr Suresh Sivanesan
  • Dr Rodney Omond
  • Dr Jacqui Richmond
  • DB Results
  • Hepatitis Australia
  • Mr Ian Baker

Acknowledgments & Declarations

HealthElink has received funding grants from the Royal Melbourne Foundation, Merck-Sharpe-Dohme and Bristol-Myers-Squibb

  • The Adelaide Liver Group
  • Prof Meredith Temple-Smith
  • Shine SA
  • A/Prof Amanda Nicoll
  • A/Prof Geoff Hebbard
  • Prof Danny Liew
  • Adelaide and Rural SA PHN
  • ASHM

For more information, visit http://www.healthelinkstudy.com.au

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  • Hepatitis C Image: Piver E, Boyer A, Gaillard J, Bull A, Beaumont E, Roingeard P, et al. Ultrastructural organisation of HCV from the bloodstream of infected patients

revealed by electron microscopy after specific immunocapture. Gut. BMJ Publishing Group; 2017 Aug;66(8):1487–95.

  • Liver Cirrhosis Image: Courtesy http://www.meddean.luc.edu/lumen/meded/orfpath/images/fig78x.jpg
  • 1. Hajarizadeh B, Grebely J, McManus H, et al. Chronic hepatitis C burden and treatment uptake in Australia: updated figures at the beginning of a new era [abstract].

HEP DART 2015: Frontiers in Drug Development for Viral Hepatitis. Global Antiviral Journal 2015; 11 Suppl 3: 85-86.

  • 2. Chart adapted from information contained in: Bertino G, Ardiri A, Proiti M, Rigano G, Frazzetto E, Demma S, et al. Chronic hepatitis C: This and the new era of
  • treatment. WJH. Baishideng Publishing Group Inc; 2016 Jan 18;8(2):92.
  • 3. Australian Federal Government, Department of Health and Aging. Media Release 22nd December 2015. “Turnbull Government Invests over $1B to cure Hep C”.

Accessible from: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley154.htm

  • 4. The Kirby Institute. Monitoring Hepatitis C treatment uptake in Australia. 2017 July pp. 1–7.
  • 5. Rubin J, Chisnell D. Handbook of Usability Testing. John Wiley & Sons; 2011. 1 p.

References

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