May 13, 2016
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Cherokee Nation Health Services increase screening, treatment of HCV

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After implementation of a tribal hepatitis C virus infection testing policy and Extension for Community Healthcare Outcomes telehealth program, the Cherokee Nation Health Services greatly increased screening and treatment rates, according to new research published in Morbidity and Mortality Weekly Report.

“Our findings are important because they reveal that by relatively simple interventions, a health care system can improve the HCV screening rates as well as engage patients in care, treatment and cure,” Jorge Mera, MD, FACP, director of infectious diseases, Cherokee Nation Health Services, Oklahoma, told Healio.com/Hepatology. “The interventions that increased our HCV screening rates sixfold were an electronic health reminder for HCV screening and basic education about HCV to our medical providers and allied health professionals.”

Jorge Mera, MD, FACP

Jorge Mera

In October 2012, the Cherokee Nation Health Services (CNHS) — an independent network of one hospital and eight clinics servicing American Indian/Alaska Native communities located in Oklahoma — implemented a tribal HCV testing policy. As part of the policy, the CNHS added a reminder in the electronic health record for clinical decision support and provided further HCV education to primary care physicians. In July 2014, the CNHS implemented the Extension for Community Healthcare Outcomes program to increase PCP capacity to care for patients with HCV.

“The tool that we used to train the primary care providers was the Extended Community Health Outcomes (ECHO) telehealth program,” Mera said. “It would have been almost impossible to train our primary care providers without it since they assist patients in clinics located in rural northeastern Oklahoma that are far away from our main hospital.”

In addition to these two programs, the CNHS also created a HCV registry to monitor care for patients with HCV on antiviral treatment and public health nurses began reaching out to patients with HCV.

To identify what impact these new strategies had on the Cherokee nation, Mera and colleagues analyzed data from the electronic health records and HCV registry systems from October 2012 and July 2015.

The researchers found that the cumulative proportion of the population tested for HCV increased fivefold from 3.6% to 18.2%. By July 2015, 39.5% of individuals tested were baby boomers, which represented a sixfold increase.

A total of 57.5% of patients with chronic HCV initiated treatment — 89.6% achieved a sustained virologic response. The researchers noted that as more antiviral agents became available, the number of patients treated for HCV increased over time — more than 15 individuals initiated treatment in 8 of 19 months.

Mera credited the incorporation of PCPs into the intervention as a major reason for the increased screening and treatment.

“The intervention that increased the number of patients with HCV into care and treatment was the incorporation of primary care providers (physicians, nurse practitioners and clinical pharmacists) into HCV management,” Mera said. “In my opinion, with an HCV epidemic affecting 3.5 million persons in the USA, it is extremely important to train primary care providers in HCV management.”

The CNHS has since expanded its program to include a clinical phase to implementation of broad-based HCV screening, care and treatment in CNHS, expanded the HCV screening policy to include adults aged between 20 and 69 years and increased clinical captivity to 20 PCPs and eight pharmacists trained as HCV care providers in their area, according to the research.

Disclosure: The researchers report no relevant financial disclosures.