Published May 7, 2019
A UB faculty member who has pioneered the use of telemedicine to treat hepatitis C virus (HCV) patients who are in opioid treatment programs shared the successes of this approach with the National Academy of Medicine (NAM) on Monday in Washington, D.C.
Andrew H. Talal, professor of medicine in the Jacobs School of Medicine and Biomedical Sciences at UB, was invited to discuss how his program, which integrates the treatment of substance abuse and HCV, can achieve better outcomes through telemedicine.
The National Academies of Sciences, Engineering, and Medicine are studying these issues as part of an effort funded by the U.S. Department of Health and Human Services’ Office of HIV/AIDS and Infectious Disease Policy that is investigating best practices for integrating substance use treatment and infectious disease treatment programs.
HCV is a casualty of the national opioid epidemic: A majority of those who have it are substance users who share needles. It affects about 5 million people in the U.S. and in 2014, killed a record 20,000 Americans, according to the Centers for Disease Control and Prevention. HCV causes more deaths than 60 other reportable infectious diseases combined. The incidence is expected to grow exponentially in the next decade, especially among opioid users, but they rarely receive treatment, Talal says. The integration of “virtual management” of HCV treatment with opioid treatment through the use of telemedicine is seen as a way to reach and treat this vulnerable population.
So far, outcomes from pilot studies have been promising. In 2018, Talal published reports on the use of telemedicine to treat HCV in patients on methadone in the journals Clinical Infectious Diseases, and Telemedicine and E-Health, both of which found that patients in opioid treatment programs were accepting of telemedicine-based HCV management.
His research is finding that treatment integration through telemedicine is especially well-accepted by patients from underrepresented groups, and that concerns about privacy and confidentiality abate as treatment progresses.
At the NAM, Talal will speak about how his program works, how patients perceive the program and the factors that promote or inhibit the successful integration of these services.
Talal’s research is supported by a $7 million grant from the Patient-Centered Outcomes Research Institute (PCORI), which Congress authorized to conduct evidence-based research to identify the most effective health care approaches.
The purpose of the award was to find an effective way to treat drug users who have HCV, a population that has traditionally been difficult to treat in conventional health care settings. Even when receiving regular treatment for substance use at methadone clinics, these patients often don’t seek treatment for HCV, despite the fact that roughly half of them or more are likely to be chronically infected.
“The conventional method of treatment delivery — referral to an offsite location — has discouraged many individuals from initiating or completing treatment,” Talal explains. “Now that we have all oral treatments with improved efficacy and almost no side effects, more patients should be lining up to be treated. The problem is that there are limited numbers of providers. The ability to link patients to providers via telemedicine removes geography as a barrier to implementation of high-quality specialty care.”
Many of these patients suffer from mental health conditions, he notes, and they are more likely to be affected by poverty and a lack of social support, factors that may deter them from seeking treatment in conventional clinical settings.
Talal expressed optimism that the NAM may view telemedicine as a valuable way to address HCV in substance users, noting that reimbursement for it is a key consideration.
“While telemedicine is an effective method to manage patients with reduced cost, reimbursement lags behind conventional in-person visits.” Talal says. “In order for telemedicine to reach its full potential, reimbursement for telemedicine visits should be equitable to seeing a doctor in an office. Equitable reimbursement for telemedicine is required to ensure financial sustainability, and is the next area we need to focus on.”