The Advantages of Telemedicine and Access to Care in Undueased Areas

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Eugenia Wade
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1 Management of Hepatitis C via Telemedicine Consultation and Teleconferencing Lorenzo Rossaro, MD, FACP, AGAF Division of Gastroenterology and Hepatology University of California Davis Medical Center Sacramento, CA lrossaro@ucdavis.edu

3 UC Davis Telemedicine Referral Network L. Rossaro et al. Practical Gastroenterology, April 2003

4 Telemedicine and Access to Care TM raises the standards of care in underserved areas by eliminating the distance barrier for many specialties It allows specialist consultation in the patients communities TM saves money and time spent traveling to urban areas or major medical centers

5 Telemedicine and Education TM encourages the participation of the PCP in the direct care of the patient PCPs can collaborate with and learn from the specialists about the current management of specialized diseases

6 Torruellas C et al. Advances in Telemedicine: Applications in Various Medical Disciplines and Geographical Regions, pp ;2011 The Triad of Education and Consultation

8 Telemedicine and Hepatitis C The Peach Tree Clinic Model Underserved area: Yuba County Primary care settings Difficult access to GI specialist Motivated Providers

9 Hepatitis C Videoconferencing: The Impact on Continuing Medical Education for Rural Healthcare Providers Comparing two learning models: Video = Videoconferencing, multipoint CME = Standard CME lectures Rossaro L et al. Telemed J E Health Jun;13(3):269-77

10 METHODS (3) Sites - 8 rural clinics throughout northern CA Participants (n=175) - Selected Categories: MD (n=68), NP/PA (n=27), and RN (n=80)

11 Learning by Groups MDs, NPs/PAs, RNs (mean) ** p< ** Video CME MDs NPs/Pas RNs

12 CONCLUSIONS Telehealth videoconferencing is equivalent, if not better, than standard CME in educating PCPs on Hepatitis C history, diagnosis and management By improving clinician education regarding HCV, videoconferencing may have a substantial impact on patient outcomes in rural areas

13 Clinical Outcomes of Hepatitis C Patients Treated with Pegylated Interferon and Ribavirin Via Telemedicine Consultation in Northern California METHODS: We performed a retrospective analysis, using standard chart review of 80 HCV patients treated at different TM sites (TM, n=40) and at the University of California Davis Hepatology Clinic (HC, n=40) between 2006 and We compared baseline characteristics and clinical outcomes Rossaro et al. Digestive Diseases and Sciences, 2013 Oct 24, epub

14 Clinical Outcomes of Hepatitis C Patients Treated with Pegylated Interferon and Ribavirin Via Telemedicine Consultation in Northern California Rossaro et al. Digestive Diseases and Sciences, 2013 Oct 24, epub

15 Summary (1) 1. Telemedicine can be an effective alternative to provide care to patients with Hepatitis C, including those who may be financially or geographically disadvantaged 2. Through telemedicine the general health care providers can learn how to make correct diagnoses, stage liver disease severity, decide if therapy is indicated, and appropriately manage the course of treatment

16 Summary (2) 3. Telemedicine outreach to rural areas and to correctional facilities is developing as an effective and innovative modality for closing the disparity gap in the access to care 4. The HCV community should approach this modality of care with an open mind and evaluate the potential advantages and longterm benefits of linking the local PCP to specialty care

17 UC Davis Model vs ECHO Our model of TM consultation involves a triangle of real-time direct consultation: patient and the PCP in the same room with video-specialist Our model differs from the ECHO that provides PCPs with HCV treatment training via Televideo-conferencing (no direct patient interaction) Our method enables simultaneous communication among the three different parties: two providers and the patient. Rossaro et al. Digestive Diseases and Sciences, 2013 Oct 24, epub

18 UC Davis Model vs ECHO UCD model allows patients to witness direct, transparent, collegial, and educative communications between providers; allows patients to ask questions & raise concerns with both their PCPs and specialist simultaneously UCD model allows providers to bill for their services, because the PCP contributes to the H & P in the presence of the patient and the specialist provides direct consultation Rossaro et al. Digestive Diseases and Sciences, 2013 Oct 24, epub

19 UCD model: future trends Individual contract agreements with institutions Per hour compensation to the specialist Flexible as needed number of hours per month Optimize the schedule (efficacy/low no show rate) Rossaro et al. Digestive Diseases and Sciences, 2013 Oct 24, epub

20 Acknowledgements Center for Health and Technology, UC Davis: Thu P. Tran, Stacey L. Cole, Richard Reiser, Jana D. Katz, Nina Parks, Patricia Keast, Thomas S. Nesbitt UC Davis Continuing Medical Education: Genell Csik Division of General Medicine, UC Davis: Julie Rainwater, Jacqueline Botros, Guiselle Clark Division of Gastroenterology and Hepatology, UC Davis: Cara Torruellas, Sandeep Dhaliwal, Marcella Agozzino, Kanat Ransibrahmanakul, Colette Prosser, Chris Aoki, Chin-Shang Li

Recruitment and Retention. Nina Parks, MA GI Hepatology Internal Medicine University of California, Davis

Recruitment and Retention. Nina Parks, MA GI Hepatology Internal Medicine University of California, Davis Recruitment and Retention Nina Parks, MA GI Hepatology Internal Medicine University of California, Davis Recruitment Plans PI s are expected to identify eligible patients: 1. Clinics 2. Databases (i.e.