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….

@jamesharid

y

Ref 2,3

The first 12-months

@jamesharid

y

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

@jamesharid

y

• 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

@jamesharid

y

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

@jamesharid

y

The HealthElink study

Aim

To determine the feasibility, efficacy and acceptability of an

eHealth system in the community treatment of hepatitis C

@jamesharid

y

2014 2015 2016 2017 2018 2019

Timeline

Development

@jamesharid

y

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

@jamesharid

y

v

2. The HealthElink Study

Prospective multicenter trial

Target 500 non-specialist referrals

Prison services in NT / SA

@jamesharid

y

• 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

@jamesharid

y

• 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

@jamesharid

y

• 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

@jamesharid

y

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

@jamesharid

y