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Telemedicine takes focus in study of HCV treatment in methadone centers
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With $7 million from the Patient-Centered Outcomes Research Institute, seven opioid treatment programs announced entry into an ongoing study of telemedicine for treatment of hepatitis C.
“The concept of the telemedicine model is that we are taking advantage of the ambience of the environment within the methadone programs, where patients generally feel more comfortable than conventional health care settings,” Andrew H. Talal, MD, from the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, told Healio Gastroenterology and Liver Disease. “We’re taking advantage of that to integrate HCV treatment into that already existing relationship.”
The Coalition of Medication-Assisted Treatment Providers and Advocates of New York State announced that seven of its member opioid treatment programs are participating in the ongoing study conducted by the University of Buffalo to evaluate the efficacy of integrating a telemedicine model to treat hepatitis C among substance users, according to a press release from the nonprofit organization. The Patient-Centered Outcomes Research Institute awarded $7 million to the University of Buffalo for the study, titled: “Comparison of Telemedicine to Usual Care for HCV Management for Methadone-maintained Individuals.”
The ongoing study follows promising results from a pilot study, published in Clinical Infectious Diseases, in which Talal and colleagues assessed the efficacy of HCV management via telemedicine in an opioid treatment program (OTP) in 62 patients.
Currently, researchers have enrolled more than 500 individuals across the 12 OTP locations among the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State (COMPA) members and expect more than 600 enrolled patients by study end.
Talal explained that the telemedicine model integrates a case manager employed by the study, most often an employee of the OTP as well, who is responsible for scheduling appointments on-site with a specialist they can speak with over camera. The other main component of the model includes a specialist pharmacy that can deliver medications to the OTP that can then be co-administered with methadone.
“There has been a lot of interest in utilizing telemedicine lately for opioid addiction treatment, but there are complications because the medications are often tied up with regulations,” Allegra Schorr, president of COMPA, told Healio Gastroenterology and Liver Disease. “This is a much more practical way of ensuring these patients can receive specialty care. Many of our patients have so many comorbidities, so having specialists available is invaluable.”
Schorr continued to explain that the integration of HCV care via telemedicine into the OTP system is also a valuable opportunity to raise awareness among the public and the health care field that methadone clinics offer more than medication delivery.
“We offer a full-range of health care,” Schorr said. “We need to fight the stigma and certain misconceptions. Unfortunately, there can often be an old mindset that methadone clinics don’t offer a full range of health care, and this study highlights that this kind of work is happening in these programs, that there’s academic research happening here.”
Talal concluded that, with the large number of patient participants and the prospective data being collected related to adherence factors and patient-reported outcomes, this study will provide an important evidence base to justify the telemedicine model as a standard of care.
“We’re showing that research can be conducted in these sites compared to previous thought,” he said. “This can also provide an opportunity to bring treatment for other types of conditions to these individuals, thereby potentially offering them another outlet besides going to a conventional health care setting.” – by Talitha Bennett
Reference: Talal AH, et al. Clin Infect Dis. 2018;doi.org/10.1093/cid/ciy899.
Disclosure: Schorr reports no relevant financial disclosures. Talal reports he has received research support from Abbott Laboratories, AbbVie and Gilead; and consults for AbbVie and Gilead.