title: The Role of e-Health in Optimizing Task-Shifting in the Delivery of Antiviral Therapy for Chronic Hepatitis C.
abstract: Recently, we reported the successful application of task-shifting to improve the management of patients with chronic hepatitis C virus (HCV) infection receiving treatment with direct-acting antiviral (DAA) agents in underserved areas of California. We assessed the impact of e-health on task-shifting in our treatment model.
  
  
  
  In a retrospective analysis, we reviewed the impact of e-health on optimizing the delivery of DAA-based regimen to HCV-infected patients in outreach clinics in medically underserved areas of California. A nonphysician healthcare provider worked in close conjunction with a hepatologist to monitor the patients during the course of antiviral therapy. We exclusively used our institution-based, secured e-health portal as the means of communication with the local staff and patients in outreach clinics.
  
  
  
  From January 2015 to June 2016, we treated over 100 HCV-infected patients with DAA-based regimens using the task-shifting model. During the study period, we did not experience any delay in the care of our patients undergoing treatment with DAA agents. Communication with the patient and staff using e-health was prompt, secured, and documented in electronic medical records. Due to the optimization of task-shifting by e-health and safety/tolerability of DAA, 95% patients did not need a follow-up clinic visit during the treatment. Return clinic visits during the treatment were unrelated to DAA use or associated with ribavirin-related anemia. In addition, we noted improvement in access and capacity of our outreach clinic.
  
  
  
  We report a positive impact of e-health in optimizing task-shifting for DAA in HCV-infected patients in underserved outreach clinics. More importantly, a secondary improvement in access and capacity of our clinic was noted.
authors.affiliation: 1 Department of Medicine, University of Illinois College of Medicine , Chicago, Illinois.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Yoo
authors.affiliation: 2 Division of Gastroenterology and Hepatology, Stanford University School of Medicine , Stanford, California.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Perumpail
authors.affiliation: 3 Division of Gastroenterology and Hepatology, University of Tennessee Health Sciences Center , Memphis, Tennessee.
authors.forename: George
authors.initials: G
authors.lastname: Cholankeril
authors.affiliation: 2 Division of Gastroenterology and Hepatology, Stanford University School of Medicine , Stanford, California.|4 Center for Innovation in Global Health, Stanford University , Stanford, California.
authors.forename: Channa R
authors.initials: CR
authors.lastname: Jayasekera
authors.affiliation: 2 Division of Gastroenterology and Hepatology, Stanford University School of Medicine , Stanford, California.
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002140:California; D002219:Carbamates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003142:Communication; D016494:Computer Security; D003219:Confidentiality; D004338:Drug Combinations; D057286:Electronic Health Records / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006576:Heterocyclic Compounds, 4 or More Rings / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D065102:Licensed Practical Nurses / Q000458:organization & administration*; D008507:Medically Underserved Area; D000072638:Patient Portals; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000458:organization & administration; D000069474:Sofosbuvir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017216:Telemedicine / Q000458:organization & administration*
chemical_list: D000998:Antiviral Agents; D002219:Carbamates; D004338:Drug Combinations; D006576:Heterocyclic Compounds, 4 or More Rings; C000611331:sofosbuvir-velpatasvir drug combination; D000069474:Sofosbuvir
keywords: e-health; healthcare access; hepatitis C virus; task-shifting; telemedicine