ECHO Model Treats HCV Infection in Underserved Communities

From Medscape Medical News

June 1, 2011 — The Extension for Community Healthcare Outcomes (ECHO) model is an effective way to treat hepatitis C virus (HCV) infection in underserved communities, according to the results of a prospective cohort study reported online June 1 in the New England Journal of Medicine.

"The ...ECHO model was developed to improve access to care for underserved populations with complex health problem such as ...HCV infection," write Sanjeev Arora, MD, from the University of New Mexico (UNM) in Albuquerque, and colleagues. "With the use of video-conferencing technology, the ECHO program trains primary care providers to treat complex diseases."

The investigators compared outcomes of treatment of chronic HCV infection at the HCV clinic at UNM vs those at 21 ECHO sites in rural areas and prisons in New Mexico, where treatment was delivered by primary care clinicians. Sustained virologic response was the primary endpoint. Of 407 patients with chronic HCV infection who had received no previous treatment, 146 were treated at the HCV clinic at UNM, and 261 were treated at ECHO sites.

Sustained virologic response occurred in 57.5% of patients treated at the UNM HCV clinic and in 58.2% of those treated at ECHO sites (P = .89). Rate of sustained virologic response among patients with HCV genotype 1 infection was 45.8% at the UNM HCV clinic and 49.7% at ECHO sites (P = .57). At the UNM HCV clinic, 13.7% of patients had serious adverse events, as did 6.9% of those treated at ECHO sites.
"The results of this study show that the ECHO model is an effective way to treat HCV infection in underserved communities," the study authors write. "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."
Study limitations include lack of a comparison group treated in rural areas without the ECHO model, lack of randomization, and possible unmeasured confounding.

In an accompanying editorial, Thomas D. Sequist, MD, MPH, from Harvard Medical School in Boston, Massachusetts, notes that the successful implementation of the ECHO model requires an adequate infrastructure for health information technology.

"The barriers to access to needed specialty care for underserved populations are well documented," Dr. Sequist writes. "Arora and colleagues have taken a promising step toward bridging this gap in care, and we can now turn our attention towards strategies for expanding such innovative care models throughout the U.S. health care system."

The Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, the New Mexico Department of Health, and the New Mexico State Legislature supported this study. Dr. Arora has disclosed various financial relationships with ZymoGenetics, Genentech, Vertex Pharmaceuticals, Tibotec, Human Genome Sciences, Wyeth (now part of Pfizer), Schering-Plough, and Genentech-Roche.

The other study authors have disclosed no relevant financial relationships. Disclosure forms provided by Dr. Sequist are available at the New England Journal of Medicine Web site .

N Engl J Med. Published online June 1, 2011.

Abstract Full text editorial