Hepatitis C screening

In a CMAJ news article, Fralick1 reports that it is unclear how Canadian hepatologists, who can barely manage their current caseloads, will be able to meet the inevitable increased demand for care created by wider screening.

Project ECHO (Extension for Community Healthcare Outcomes) was developed in 2003 by Dr. Sanjeev Arora, a hepatologist at the University of New Mexico, in Albuquerque, to address this problem via weekly video clinics with widely dispersed primary care providers. Case discussions and didactic lectures support the provision of evidence-based treatments in patients’ hometowns.

This learning-by-doing model led to an increase in the number of patients in New Mexico who were cured of hepatitis C. Clinical outcomes of patients treated in the community matched those outcomes achieved in the University setting.2 Those cured of hepatitis C have been shown to have had a 93% reduction in liver-related mortality and a 74% reduction in 10-year all-cause mortality.3 Liver cancer rates declined by 76%.3 Effective treatment results in a reduction in costly liver transplants and management of liver cancer.

Access to treatments for addiction has increased via the Integrated Addictions and Psychiatry TeleECHO Clinic. ECHO-linked primary care providers offer vaccination for hepatitis A and B and education on prevention, alcohol cessation, hepatotoxic drug avoidance and nicotine and marijuana cessation to reduce rates of liver fibrosis.

By providing primary care providers with the skills and the support to practise at the highest level of their competence, ECHO can redress geographic imbalances in access to specialist care. The ECHO model also leads to rapid dissemination of best practices, increased primary care provider satisfaction and self-efficacy in managing complex chronic diseases, and improved patient outcomes.4