1 Department of Medicine, University of Illinois College of Medicine , Chicago, Illinois.
2 Division of Gastroenterology and Hepatology, Stanford University School of Medicine , Stanford, California.
Telemed J E Health. 2017 Oct;23(10):870-873. doi: 10.1089/tmj.2016.0189. Epub 2017 Apr 4.
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.
最近，我们报告了任务转移在改善加利福尼亚州服务不足地区接受直接作用抗病毒 (DAA) 药物治疗的慢性丙型肝炎病毒 (HCV) 感染患者管理方面的成功应用。我们评估了电子健康对我们治疗模式中任务转移的影响。
在回顾性分析中，我们评估了电子健康对优化加利福尼亚州服务不足地区外展诊所中 HCV 感染患者 DAA 方案治疗的影响。非医师医疗保健提供者与肝病专家密切合作，在抗病毒治疗过程中监测患者。我们仅使用我们机构内部的安全电子健康门户作为与外展诊所的当地工作人员和患者进行沟通的手段。
从 2015 年 1 月至 2016 年 6 月，我们使用任务转移模型治疗了 100 多名接受 DAA 方案治疗的 HCV 感染患者。在研究期间，我们的患者接受 DAA 药物治疗的护理没有任何延迟。使用电子健康与患者和工作人员的沟通及时、安全且记录在电子病历中。由于电子健康优化了任务转移和 DAA 的安全性/耐受性，95%的患者在治疗期间不需要进行随访诊所就诊。治疗期间的就诊返回与 DAA 的使用或与利巴韦林相关的贫血无关。此外，我们注意到我们的外展诊所的可及性和能力得到了改善。
我们报告了电子健康在优化服务不足的外展诊所中 HCV 感染患者 DAA 治疗中的任务转移方面的积极影响。更重要的是，我们的诊所的可及性和能力得到了二级改善。
