The Dose

Welcome to The Dose, which tackles the business and economics inside the turbulent world of health care and life sciences in Indiana. Your host is John Russell. To contact me call 317-472-5383.

Indiana health officials try to fight hepatitis C epidemic with videoconferencing

February 5, 2018

Indiana’s growing epidemic of hepatitis C—an often-deadly liver disease linked to injection drug use and dirty syringes—is prompting health officials to take a new approach to share information.

Many rural counties, where the outbreaks are occurring in tandem with the opioid crisis, have few if any doctors who specialize in liver care or infectious diseases.

So patients there often must travel to a large city to see a specialist, or in some cases just don’t get care, said Dr. Joan Duwve, chief medical officer for the Indiana State Department of Health and associate dean of public health practice in the Richard M. Fairbanks School of Public Health.

To overcome that, a partnership of Indiana University, the state health department and a company called MedIQ has launched a program called Project ECHO, which uses videoconferencing to conduct virtual clinics between specialists in Indianapolis and primary care doctors in rural Indiana.

The video clinics, held twice a month, can connect up to 25 participants to discuss cases, learn from each other, and pass along information to patients, saving them from long drives to see specialists.

Caring for patients with hepatitis C can be complex. Some continue to inject drugs while they are being treated. The medications require complicated dosing regimens for up to 12 weeks. Often, primary care doctors don’t have the expertise to develop treatment plans, Duwve said.

The epidemic is mushrooming. The number of acute hepatitis C cases in Indiana has increased by 400 percent in recent years, from 28 in 2010 to 130 in 2015, according to the Indiana State Department of Health

“Hepatitis C is one of those viruses you can be infected with and not know for a very long time,” Duwve said.

Over time, it can lead to loss of liver cells, irreversible scarring of the liver and even liver cancer. It can be fatal if an infected person doesn’t get treated with drugs that often have complex dosing regimens.

Symptoms of hepatitis C can include yellowing of the skin and eyes, loss of appetite, nausea and vomiting, fever, tiredness and stomach pain. Hepatitis C is spread primarily through contact with human blood.

People aged 18 to 39 posted the largest jump in hepatitis C cases between 2010 and 2015. That mirrors national trends with the increase in the opioid and heroin epidemic among people of these ages, the state health department said.

Project ECHO was developed at the University of New Mexico more than a decade ago and is now used in dozens of states. Indiana is the 39th state to take part.

The clinics are available to health care providers at no charge and require only basic video and IT equipment. Health care providers who want to participate can call the program at (317) 274-3178.

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