Sean M. Burke, MD, Indira Bhavsar, MD, Kimberly Dowdell, MD, Curtis Argo, MD
University of Virginia Health System, Charlottesville, VA
Introduction: The incidence of chronic liver disease in the United States is increasing and leading to a disproportionate number of patients for every gastroenterologist and a growing coverage gap in care. Electronic consultation (eConsult) is an asynchronous, text-based question-response between provider and consultant without consultant-patient contact that may improve access to hepatitis C virus (HCV) treatment. The purpose of this study is to assess treatment and referral patterns of HCV infections among primary care physicians and to further assess the role of eConsults in the treatment of chronic hepatitis C (CHC).
Methods: Primary care physicians (PCPs) associated with a large tertiary teaching hospital with a robust eConsult program were surveyed via an optional online questionnaire. Responses from urban, suburban, and rural resident and attending practitioners were anonymously recorded over a three month time spanning from March 1, 2019 to June 1, 2019 with regard to their current evaluation and management of patients with CHC.
Results: Fifty nine responses to the survey were generated. Of those surveyed, 0 providers treated HCV without referral to a specialist. The top three issues identified as barriers to treatment included “not enough information on protocol”, “not enough volume of patients to make it worth learning”, and “administrative hurdles.” 83% of those surveyed would be more open to treating HCV if they were provided administrative assistance and indicated that a centralized eConsult for HCV treatment provided adequate administrative support. 41% of physicians surveyed reported that less than half of their patients referred for treatment are ultimately linked to specialty care. Only 22% of providers felt that patient satisfaction would be negatively impacted without a subspecialty consult to manage HCV treatment.
Discussion: Our results indicate that PCPs do not routinely treat CHC infection though the vast majority of them would be interested in doing so given the percentage of their patients left without linkage to specialty care. This study identifies eConsults as a modality for expanding treatment of CHC by task-shifting treatment of the disease to PCPs through a uniform and stream-lined eConsult model, which would ultimately improve access to care, improve healthcare expenditures, and limit the direct burden placed on patients to see multiple providers.
Citation: Sean M. Burke, MD, Indira Bhavsar, MD, Kimberly Dowdell, MD, Curtis Argo, MD. P1524 - HEP C: HELPING EVERYONE PROVIDE A CURE. Program No. P1524. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.