Curtis Cooper, MD, FRCPC Associate Professor of Medicine University - - PowerPoint PPT Presentation

Curtis Cooper, MD, FRCPC Associate Professor of Medicine University of Ottawa Director- The Ottawa Hospital and Regional Viral Hepatitis Program

Disclosures

 Presenter: Curtis Cooper  Relationships with commercial interests  Grants/Research support: ABV, GS, MK  Speakers Honoraria: ABV, GS, MK, BMS  Consulting Fees: ABV, GS, MK  Other: OHTN, U Ottawa

Collaborative Efforts to Manage HCV: Telemedicine

Telemedicine

 Use of telecommunication and information

technologies with the goal of providing clinical health care to distant or isolated individuals.

 Can eliminate distance barriers and improve medical

services access that otherwise would not be available.

Parmvir Parmar, David Mackie, Sunil Varghese, Curtis Cooper. The Use of Telemedicine Technologies in the Management of Infectious Diseases: A Review. Clinical Infectious Diseases 2015

Telemedicine at TOH

 Over 150 TOH TM users, over 400 patients

seen/month

 Mixed model of regular clinic / ad hoc visits  Over 20 clinical services  Videoconferencing available to any TOH physician at

any TOH campus

 Scheduling support is offered by the telemedicine

• ffice

Benefits of Telemedicine

 Telemedicine technology has the ability to overcome

many barriers for accessing health care in a timely manner:

 remote communities with travel hardships  economic barriers  immobile patients  limited availability of specialists  comprehensive referral information

TOHVHP Building Community Capacity for HCV Care and Cure Program

 The overall objective is to develop community based expertise in

HCV care and treatment in Cornwall, Pembroke, Smith Falls, Renfrew and Hawkesbury and Nunavut Territory.

 Other in-need communities will be added as required.  The specific goals are:

 Increase the number of health care personnel providing HCV care  Increase the number of patients with HCV monitored by local

health providers

 Increase the number of patients with HCV treated  To ensure that HCV care and treatment is equivalent to care

provided at the TOHVHP

Building Community Capacity for HCV Care and Cure Timelines and Project Flow: Metrics April 2015 –Present

Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

TOHVHP Telemedicine Program

Ongoing

Partner Identification: CME events in target communities

Ongoing

Partner Training at the TOHVHP

Ongoing

Onsite Partner Training

Ongoing

Case Based Discussion Sessions

x x x x

Data Collection

Ongoing

Interim Analysis and Outcome Evaluation

x x x x

Knowledge Translation and Exchange

Ongoing

TOHVHP Telemedicine Stats



Overall



300+ participants



50+ patients treated / on-treatment



2015



260 patients seen



30 on treatment



Consults (Jan - Sept 2015)



78 referrals (5-16 / month) 

Sites



Cornwall x 20



Hawkesbury x 8



Renfrew x 7



Smith Falls x 4



Arnprior x 4



Perth, Almonte, Kemptville, Pembroke, Athens, South Mountain, Carleton Place, Carp, Morrisburg, Brockville, Prescott, Pettawawa, Williamsburg, Constance Bay (West Locations x 1-2 / site)



Vankleek Hill, Alfred, Akwasasne, Alfred, Alexandria, Crylser (East x 1 or 2)



North Bay, New Lisgard, Iqualuit, Thunder Bay (North x 1 each) 

Fibroscan



4 blitzs 

Education



1 CME



2 lunch and learns for nurses

Ottawa TM Assessment

 A cohort database analysis was performed on patients

followed at TOHVHP between Jan 2012 and Aug 2016.

 Patients older than 18 years of age and those infected

with chronic HCV were included.

 TM (n=174) and non-TM (n=2162) patients were

compared by examining baseline characteristics and clinical outcomes.

 Data was collected using charts and electronic medical

records in TOHVHP database.

Results



TM patients were more likely to be Indigenous (7.0% vs 2.2%), GT3 infected (25.9% vs 16.4%), and to have a history of IDU (70.1% vs 54.9%), alcohol use (69.4% vs 56.9%), and incarceration (46.5% vs 35.5%).



Similar in age (mean 48.9), gender (63.7% male) and cirrhotic stage (24.0%).



The length of HCV infection was shorter in TM patients (2o.7 years vs 26.7 years).



TM patients were less likely to be HIV co-infected (0.6% vs 6.6%) and more likely to have material deprivation (31.8% vs 17.0%).



TM patients were less likely to be biopsied (15.9% vs 39.2%) and less likely to initiate IFN- based treatment.



TM patients were equally likely to undergo Fibroscan and to initiate DAA-based treatment.



DAA SVR rate in the TM group was 94.7% and 94.8% in the non-TM group (p=0.995).



Indigenous population, and Genotype 3 associated with less likelihood of achieving SVR.

Conclusions

 Our TM program successfully engages and retains a

remote population exhibiting characteristics that are associated with barriers to successful HCV treatment.

 Fibroscan technology and DAA-based treatments have

helped to enable these outcomes.

 TM patients were able to engage in HCV care,

achieving high SVR rates comparable to those

• btained by Outpatient Clinic care.

Challenges

 No shows / Lost to Follow-Up  Engaging all Marginalized Groups  Patient Deterioration  Laboratory Results  Medication Funding  Staffing turnover  Identifying partners  Engaging trainees  Assessment

 Evaluation questionnaires  Maintaining dataset

Lessons Learned

 Can be done  Highly dependent on the

staff responsible for the role

 Need a solid

understanding of staff role and HCV

 Need to determine way

to determine who is serious about training and who is trainable

Collaborative Efforts to Manage HCV: Community Liaison Program

Acknowledgement

 Patients  TOH Viral Hepatitis Program Team  Ministry of Health  Audience