SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/12  
 
  2018 Dec;68(6):2317-2324.  
  doi: 10.1002/hep.30074  
 
  Virtual Consultations Through the Veterans Administration SCAN-ECHO Project Improves Survival for Veterans With Liver Disease.  
 
  Su GL, Glass L, Tapper EB, Van T, Waljee AK, Sales AE  
  https://www.ncbi.nlm.nih.gov/pubmed/29729194  
 
 

Abstract

Access to specialty care has been associated with improved survival in patients with liver disease but universal access is not always feasible. Methods of care delivery using virtual modalities including the SCAN-ECHO (Specialty Access Network-Extension of Community Healthcare Outcome) program were implemented by the Veterans Health Administration (VHA) to address this need but limited data are available on patient outcomes. We sought to evaluate the efficacy of a SCAN-ECHO visit within the context of a regional cohort of patients with liver disease in the VHA (n = 62,237) following implementation in the Ann Arbor SCAN-ECHO Liver Clinic from June 1, 2011, to March 31, 2015. The effect of a SCAN-ECHO visit on all-cause mortality was compared with patients with no liver clinic visit. To adjust for the differences among patients who had a SCAN-ECHO visit versus those with no visit, propensity score matching was performed on condition factors that affect the likelihood of a SCAN-ECHO visit: demographics, geographic location, liver disease diagnosis, severity, and comorbidities. During the study period, 513 patients who had a liver SCAN-ECHO visit were found within the cohort. Patients who had completed a virtual SCAN-ECHO visit were more likely younger, rural, with more significant liver disease, and evidence for cirrhosis. Propensity-adjusted mortality rates using the Cox Proportional Hazard Model showed that a SCAN-ECHO visit was associated with a hazard ratio of 0.54 (95% confidence interval 0.36-0.81, P = 0.003) compared with no visit. Conclusion: Improved survival in patients using SCAN-ECHO suggests that this approach may be an effective method to improve access for selected patients with liver disease, particularly in rural and underserved populations where access to specialty care is limited.

 

 
Question posée
 
Etude de l’efficacité d’une aide virtuelle à la prise en charge des patients ayant une maladie chroniquer du foie à partir de SCAN-ECHO (Specialty Access Network-Extension of Community Healthcare Outcome), programme utilisé par l’administration en charge de la santé des vétérans américains, en ajustant avec un score de propension basé sur les facteurs démographiques, la localisation géographique, le diagnostic de la maladie hépatique, la sévérité de la maladie hépatique et les comorbidités.
 
Question posée
 
De 2011 à 2015, les 513 patients suivis dans le cadre du programme SCAN-ECHO étaient plus jeunes, avec une maladie du foie plus grave et avec cirrhose. La mortalité « ajustée » était significativement plus faible (OR:0,54) comparée à celle des patients sans visite SCAN-ECHO.
 
Commentaires

Importance du suivi même virtuel dans le pronostic des maladies chroniques du foie. Outil à réfléchir et à adapter dans les zones pauvres en ressources médicales.

 
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