title: Outcomes of treatment for hepatitis C virus infection by primary care providers.
abstract: BACKGROUND
  The Extension for Community Healthcare Outcomes (ECHO) model was developed to improve access to care for underserved populations with complex health problems such as hepatitis C virus (HCV) infection. With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases.
  
  
  METHODS
  We conducted a prospective cohort study comparing treatment for HCV infection at the University of New Mexico (UNM) HCV clinic with treatment by primary care clinicians at 21 ECHO sites in rural areas and prisons in New Mexico. A total of 407 patients with chronic HCV infection who had received no previous treatment for the infection were enrolled. The primary end point was a sustained virologic response.
  
  
  RESULTS
  A total of 57.5% of the patients treated at the UNM HCV clinic (84 of 146 patients) and 58.2% of those treated at ECHO sites (152 of 261 patients) had a sustained viral response (difference in rates between sites, 0.7 percentage points; 95% confidence interval, -9.2 to 10.7; P=0.89). Among patients with HCV genotype 1 infection, the rate of sustained viral response was 45.8% (38 of 83 patients) at the UNM HCV clinic and 49.7% (73 of 147 patients) at ECHO sites (P=0.57). Serious adverse events occurred in 13.7% of the patients at the UNM HCV clinic and in 6.9% of the patients at ECHO sites.
  
  
  CONCLUSIONS
  The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities. Implementation of this model would allow other states and nations to treat a greater number of patients infected with HCV than they are currently able to treat. (Funded by the Agency for Healthcare Research and Quality and others.).
authors.affiliation: Department of Internal Medicine, University of New Mexico, Albuquerque, USA. sarora@salud.unm.edu
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Arora
authors.forename: Karla
authors.initials: K
authors.lastname: Thornton
authors.forename: Glen
authors.initials: G
authors.lastname: Murata
authors.forename: Paulina
authors.initials: P
authors.lastname: Deming
authors.forename: Summers
authors.initials: S
authors.lastname: Kalishman
authors.forename: Denise
authors.initials: D
authors.lastname: Dion
authors.forename: Brooke
authors.initials: B
authors.lastname: Parish
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
authors.forename: Wesley
authors.initials: W
authors.lastname: Pak
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dunkelberg
authors.forename: Martin
authors.initials: M
authors.lastname: Kistin
authors.forename: John
authors.initials: J
authors.lastname: Brown
authors.forename: Steven
authors.initials: S
authors.lastname: Jenkusky
authors.forename: Miriam
authors.initials: M
authors.lastname: Komaromy
authors.forename: Clifford
authors.initials: C
authors.lastname: Qualls
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use; D003153:Community Health Services; D005260:Female; D006297:Health Services Accessibility; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000628:therapy* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009516:New Mexico; D058007:Physicians, Primary Care; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D011994:Recombinant Proteins; D019035:Rural Health Services; D017216:Telemedicine; D016896:Treatment Outcome; D049269:Videoconferencing
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; C100416:peginterferon alfa-2a