Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region.
Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region.
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开发针对高负担地区丙型肝炎和阿片类药物使用障碍的提供者培训和综合护理的跨学科远程医疗模型。
DOI：
10.1093/infdis/jiaa141
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Dillingham,Rebecca
中科院分区：
文献类型：
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作者：
Sherbuk,JacquelineE;Knick,TerryKemp;Canan,Chelsea;Ross,Patrice;Helbert,Bailey;Cantrell,EleanorSue;Cantrell,CharleneJoie;Stallings,Rachel;Barron,Nicole;Jordan,Diana;McManus,KathleenA;Dillingham,Rebecca
背景丙型肝炎病毒（HCV）和阿片类药物流行不成比例地影响阿巴拉契亚地区。地理和经济上的障碍阻碍了获得专科护理。需要采取干预措施，以解决HCV-阿片类syndrome in this region.MethodsWe开发了一个创新的，协作的远程医疗模式，在弗吉尼亚州西南部的双向转诊和全面的危害减少（ESTA）计划和办公室为基础的阿片类药物治疗（OBOT），以及劳动力发展，通过当地供应商的培训，在HCV管理。我们的目的是（1）描述供应商培训的实施过程和（2）通过监测患者的结果，在第一年评估远程医疗模式的有效性ResultsThe供应商培训模式从毕业的自治模式与直接的专家监督，为期1天的研讨会与平行轨道供应商和支持人员，然后每月的情况下会议。44名提供者和支助人员参加了培训。八家供应商已经开始独立治疗。对于远程医疗部分，123人被转介，其中62%来自合作伙伴OBOT或OBOT站点; 103人（84%）参加了访问，93人（76%）完成了治疗过程，61人（50%）实现了持续的病毒学应答。持续的病毒学反应率没有不同的阿片类药物使用disorder.ConclusionsProviders接受治疗表现出一个人的培训讲习班的偏好，虽然需要进一步的调查，以确定为什么只有少数受过训练的人已经开始独立治疗HCV。该计划的跨学科性质导致了现实世界人群中丙型肝炎的有效治疗，其中大多数患者是从OBOTs和OBT计划中转诊的。
BackgroundHepatitis C virus (HCV) and the opioid epidemic disproportionately affect the Appalachian region. Geographic and financial barriers prevent access to specialty care. Interventions are needed to address the HCV-opioid syndemic in this region.MethodsWe developed an innovative, collaborative telehealth model in Southwest Virginia featuring bidirectional referrals from and to comprehensive harm reduction (CHR) programs and office-based opioid therapy (OBOT), as well as workforce development through local provider training in HCV management. We aimed to (1) describe the implementation process of provider training and (2) assess the effectiveness of the telehealth model by monitoring patient outcomes in the first year.ResultsThe provider training model moved from a graduated autonomy model with direct specialist supervision to a 1-day workshop with parallel tracks for providers and support staff followed by monthly case conferences. Forty-four providers and support staff attended training. Eight providers have begun treating independently. For the telehealth component, 123 people were referred, with 62% referred from partner OBOT or CHR sites; 103 (84%) attended a visit, 93 (76%) completed the treatment course, and 61 (50%) have achieved sustained virologic response. Rates of sustained virologic response did not differ by receipt of treatment for opioid use disorder.ConclusionsProviders demonstrated a preference for an in-person training workshop, though further investigation is needed to determine why only a minority of those trained have begun treating HCV independently. The interdisciplinary nature of this program led to efficient treatment of hepatitis C in a real-world population with a majority of patients referred from OBOTs and CHR programs.