Wade A J, McCormack A, Roder C, McDonald K, Davies M, Scott N, Wardrop M, Athan E, Hellard M E
Department of Infectious Disease, Barwon Health, Geelong, Vic., Australia.
Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.
J Viral Hepat. 2018 Sep;25(9):1089-1098. doi: 10.1111/jvh.12910. Epub 2018 May 8.
To increase access to treatment, the Australian government enabled general practitioners (GPs) to prescribe direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV)-in consultation with a specialist if inexperienced in HCV management. This study describes the establishment and outcomes of a remote consultation pathway supporting GPs to treat HCV. Key stakeholders from primary and tertiary healthcare services in the Barwon South Western region developed and implemented an HCV remote consultation pathway. Pharmaceutical Benefits Schedule prescription data were used to evaluate GP DAA prescription 12 months pre-and post- pathway implementation. A retrospective review of patients referred for remote consultation for 12 months post- pathway inception was undertaken to determine the care cascade. HCV treatment initiation by GPs increased after implementation of the remote consultation pathway. In the 12-month study period, 74 GPs referred 169 people for remote consultation; 114 (67%) were approved for GP DAA treatment; 48 (28%) were referred for specialist assessment. In total, 119 (71%) patients commenced DAA; 69 were eligible for SVR12 assessment. Post-treatment HCV RNA data were available for 52 (75%) people; 37 achieved SVR12; 15 achieved SVR ranging from week 5 to 11 post-treatment. No treatment failure was detected. Collaborative development and implementation of a remote consultation pathway has engaged regional GPs in managing HCV. Follow-up post-treatment could be improved; however, no treatment failure has been documented. To eliminate HCV as a public health threat, it is vital that specialists support GPs to prescribe DAA.
为了增加治疗的可及性，澳大利亚政府允许全科医生（GP）开具直接抗病毒药物（DAA）来治疗丙型肝炎病毒（HCV）——如果在HCV管理方面缺乏经验，则需与专科医生协商。本研究描述了一种支持全科医生治疗HCV的远程会诊途径的建立及其结果。来自西南巴旺地区基层和三级医疗服务机构的主要利益相关者制定并实施了HCV远程会诊途径。利用药品福利计划处方数据评估该途径实施前后12个月全科医生开具DAA的情况。对该途径启动后12个月内转诊进行远程会诊的患者进行回顾性审查，以确定治疗流程。实施远程会诊途径后，全科医生启动的HCV治疗有所增加。在为期12个月的研究期间，74名全科医生转诊了169人进行远程会诊；114人（67%）被批准接受全科医生的DAA治疗；48人（28%）被转诊进行专科评估。总共有119名患者（71%）开始使用DAA治疗；69人符合SVR12评估条件。有52人（75%）可获得治疗后HCV RNA数据；37人实现了SVR12；15人在治疗后第5周至第11周实现了SVR。未检测到治疗失败情况。远程会诊途径的协同开发和实施使地区全科医生参与到HCV管理中。治疗后的随访可以改进；然而，尚未记录到治疗失败情况。为了消除HCV作为公共卫生威胁，专科医生支持全科医生开具DAA至关重要。
