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An eHealth model of care for community treatment of hepatitis C: The HealthElink study
Dr James Haridy MBBS B.Physio MPH
Gastroenterology & Hepatology Fellow, PhD Candidate
Royal Melbourne Hospital / University of Melbourne
230,000 Australians Infected1
0%
20%
40%
60%
80%
100%
1990 1998 2001 2011 2016
7%
25%
45%
70%
95%
SUST
AIN
ED V
IRO
LOG
ICA
L R
ESP
ON
SE
YEAR
We are at an incredible point in history….
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Ref 2,3
The first 12-months
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Ref 4
Why do we need GPs to prescribe this treatment?
And what are the barriers in the current model of
care?
The current problems..
Patient
Specialist GP Nurse
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• Difficult to reach high-risk populations
• Prisons
• People Who Inject Drugs
• Mental Health
• Indigenous
• Stigma
• Cannot attend specialist / hospital
• Rural/Remote
• Simply do not turn up
• Concerned about loss to followup
• Potential for missing cirrhosis
• Capacity and access
• Cost
The HealthElink system
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GP / Nurse / Specialist Portals Patient Portal
• Complex treatment algorithm• Multiple treatment plans based on hepatitis C type, fibrosis
assessment and medication interactions
• Security• Ernst and Young engaged to advised on security, including
code review and penetration testing.
• Corrs Chambers Westgarth engaged to provide advice on health data privacy compliance.
• Data storage on HIPAA compliant Amazon Web Servers
The HealthElink system
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The HealthElink study
Aim
To determine the feasibility, efficacy and acceptability of an
eHealth system in the community treatment of hepatitis C
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2014 2015 2016 2017 2018 2019
Timeline
Development
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HealthElink
Study
• 16 users in total over two early versions
• Median time for referral HealthElink 538 v 552 seconds
• Correct treatment regimen prescribed in 12/12 (100%) using HealthElink compared with 9/12 (75%) using current paper based form
• 12/12 (100%) preferred use of the HealthElink system
1. Usability study
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v
2. The HealthElink Study
Prospective multicenter trial
Target 500 non-specialist referrals
Prison services in NT / SA
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• Late 2018, purposive sampling of representative usage groups
• Users displaying both high and low activity on the system to be interviewed in semi-structured interview
• Explore acceptability and motivation behind uptake (or non-uptake) of the system
3. Qualitative study – planned in 2018
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• Trial in other chronic diseases
• Further funding to develop system further, enhance compatibility
• Mobile / app development to enhance patient experience and interactivity
• Refine based on user feedback
The future plan
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• Hepatitis C now can be cured, but we still need to get the cure out there
• Deficiencies in the traditional model of care preclude rapid and widespread implementation in primary care
• An eHealth model of care offers a solution to overcome many of the barriers to eradication
In Summary
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This research would not be possible without many others:
• Dr Guru Iyngkaran
• Dr Edmund Tse
• Dr Suresh Sivanesan
• Dr Rodney Omond
• Dr Jacqui Richmond
• DB Results
• Hepatitis Australia
• Mr Ian Baker
Acknowledgments & Declarations HealthElink has received funding grants from the Royal Melbourne
Foundation, Merck-Sharpe-Dohme and Bristol-Myers-Squibb
• The Adelaide Liver Group
• Prof Meredith Temple-Smith
• Shine SA
• A/Prof Amanda Nicoll
• A/Prof Geoff Hebbard
• Prof Danny Liew
• Adelaide and Rural SA PHN
• ASHM
For more information, visit http://www.healthelinkstudy.com.au
• Hepatitis C Image: Piver E, Boyer A, Gaillard J, Bull A, Beaumont E, Roingeard P, et al. Ultrastructural organisation of HCV from the bloodstream of infected patients revealed by electron microscopy after specific immunocapture. Gut. BMJ Publishing Group; 2017 Aug;66(8):1487–95.
• Liver Cirrhosis Image: Courtesy http://www.meddean.luc.edu/lumen/meded/orfpath/images/fig78x.jpg
• 1. Hajarizadeh B, Grebely J, McManus H, et al. Chronic hepatitis C burden and treatment uptake in Australia: updated figures at the beginning of a new era [abstract]. HEP DART 2015: Frontiers in Drug Development for Viral Hepatitis. Global Antiviral Journal 2015; 11 Suppl 3: 85-86.
• 2. Chart adapted from information contained in: Bertino G, Ardiri A, Proiti M, Rigano G, Frazzetto E, Demma S, et al. Chronic hepatitis C: This and the new era of treatment. WJH. Baishideng Publishing Group Inc; 2016 Jan 18;8(2):92.
• 3. Australian Federal Government, Department of Health and Aging. Media Release 22nd December 2015. “Turnbull Government Invests over $1B to cure Hep C”. Accessible from: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2015-ley154.htm
• 4. The Kirby Institute. Monitoring Hepatitis C treatment uptake in Australia. 2017 July pp. 1–7.
• 5. Rubin J, Chisnell D. Handbook of Usability Testing. John Wiley & Sons; 2011. 1 p.
References
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