Importance: Direct-acting antiviral (DAA) medications are highly effective in treating hepatitis C virus (HCV) infection. However, use of DAAs in rural and underserved areas is low owing to limited access to specialist physicians with experience in care of HCV infection. Project ECHO (Extension for Community Healthcare Outcomes) is a distance education model that trains primary care physicians to improve access to care for underserved populations with complex diseases such as HCV infection. Evidence on whether Project ECHO is associated with increased DAA use is limited.
Objective: To examine the association between Project ECHO and use of DAA treatment in patients with HCV infection.
Design, Setting, and Participants: This cohort study used data from Medicare beneficiaries who newly sought care for HCV infection between January 1, 2014, and December 31, 2017. Data were analyzed between September and December 2020.
Exposures: Project ECHO.
Main Outcomes and Measures: Use of DAA treatment. Discrete-time hazard models with state and year fixed effects were used to examine the association between Project ECHO and DAA use in rural areas and areas with low specialist density.
Results: A total of 267 908 patients (mean [SD] age, 60.7 [11.5] years; 57.9% male; 66.6% White patients) were included in the analysis. For every 100 clinicians attending a Project ECHO training, the odds of DAA treatment initiation among patients with HCV infection increased by 9% (adjusted odds ratio [OR], 1.09; 95% CI, 1.07-1.11; P < .001) in nonrural areas with specialist density equaling 0. The association between DAA use and Project ECHO was stronger in areas with lower vs higher specialist density. For every additional 100 Project ECHO participants, the odds of DAA use decreased by 1% as specialist density in the area increased (adjusted OR, 0.99; 95% CI, 0.98-1.00; P = .03). There was no association between Project ECHO and the odds of receiving DAAs among patients in rural vs urban areas (adjusted OR, 1.01; 95% CI, 0.99-1.02; P = .49).
Conclusions and Relevance: In this cohort study, implementation of Project ECHO was associated with increased DAA use in areas with few specialist physicians, suggesting that Project ECHO may enhance access to DAA treatment through expanding the capacity of primary care physicians to treat HCV infection, especially in underserved areas.
|Original language||English (US)|
|Journal||JAMA Network Open|
|State||Published - Jul 2 2021|
Bibliographical noteFunding Information:
Conflict of Interest Disclosures: Dr Feldman reported owning a small amount of stock in Gilead Sciences. Dr Riley reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Jung reported receiving grants from the National Institute on Aging, National Institutes of Health during the conduct of the study. No other disclosures were reported.
Funding/Support: This project was supported by grant R01 AG055636-01A1 from the National Institute on Aging, National Institutes of Health (Dr Jung).
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