Sunday, November 6, 2011

AASLD: HCV Phone Program Equals Office Visits

By Michael Smith, North American Correspondent, MedPage Today
Published: November 07, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

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Action Points
  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

  • Explain that a study comparing visits to a liver specialist versus telemedicine encounters for patients with hepatitis C found a significantly higher treatment completion rate for telemedicine patients.

  • Point out that sustained virologic response was actually higher in the telemedicine group, although not significantly different from those visiting the specialist directly.

SAN FRANCISCO -- Patients treated by telemedicine for hepatitis C do as well as those that can come to a specialist's office, a researcher said here.

And in one way -- completing the treatment -- they appear to do even better, according to Cara Torruellas, MD, of the University of California Davis.

In a retrospective pilot study, 78% of telemedicine patients completed therapy, compared with 53% of those who saw the specialists in person, and the difference was significant at P=0.03, Torruellas reported at the annual meeting of the American Association for the Study of Liver Diseases.

Remotely treated patients also had similar rates of the various adverse effects of treatment with pegylated interferon and ribavirin, she said.

The findings come from a retrospective look at 80 patients, half of them treated by hepatologists at UC Davis and half -- in rural areas or prisons -- treated using telemedicine consultations between the patients, their primary care doctors, and specialists in the city.

At Davis, Torruellas told MedPage Today, "we actually work with a lot of patients in rural areas and in prisons who lack access to specialists, and particularly liver specialists."

That lack of access has the potential to translate into a lower likelihood of treatment and in the long run a higher chance of cirrhosis or hepatocellular carcinoma, she said -- something the university telemedicine program is trying to prevent.

But it has not been clear how well that's working. To start finding out, Torruellas conducted the pilot study, which she hopes to repeat with larger numbers, to see if treatment outcomes and adverse events differed between the groups. In fact, she reported:

  • The groups were similar in terms of age, sex, ethnicity and race, hepatitis C RNA level, viral genotype, and stage of fibrosis
  • The rate of sustained virologic response was 55% in the telemedicine group and 43% among patients who visited the specialists directly, but the difference was not statistically significant
  • Most adverse events occurred at similar rates, with the exception of anemia. Patients seen in the hepatology clinic had an anemia rate of 53%, compared with 25% in the telemedicine group, which was significant at P=0.02

The difference in therapy completion may have been a result of closer follow-up by the primary care doctor, combined with more direct observation of treatment, Torruellas told MedPage Today.

And the difference in the anemia rate may reflect discomfort on the part of the primary care doctors to pursue the treatment in the face of the adverse event, she added.

But both explanations are speculative and more research is needed, she said.

The findings are additional evidence that telemedicine works for patients with hepatitis C, according to Gary Davis, MD, of Baylor University Medical Center in Dallas, who was not involved in the study.

He noted that a study by New Mexico physicians, published earlier this year, had similar results.

"It's great news," he told MedPage Today, especially in light of a new CDC study, also presented here, that suggested a new screening method might find an additional 800,000 patients.

"There are not enough liver docs to treat all those people," Davis said.

He added that access is an important issue that is only going to get more pressing, but an important policy question is how to pay specialists who get involved in telemedicine programs. He noted that many current programs are supported by grants, rather than by patient or insurance payments.

The researchers did not report external support for the study or any conflicts.

Davis reported financial links with Vertex, Tibotec, Genentech, Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Novartis, and Pharmasset.

Primary source: Hepatology
Source reference:
Torruellas C, et al "A pilot retrospective cohort study: clinical outcomes of hepatitis C patients treated with pegylated interferon and ribavirin via telemedicine consultation as compared to traditional office visits" Hepatology 2011; 54(4): Abstract 462.

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