MPH Hepatitis C Telemedicine Project: There Are Four I's in Team

How a chemist, former health care account manager, researcher project coordinator, and an MD with a background in global health—all students in Dartmouth Institute’s residential MPH program—came together to form the perfect team—one that explored an unanswered question about telemedicine for Hepatitis C 

Part 1: David and BlakeIn health care, everything we do—from research to clinical care —is as a member of a team. A good team dynamic is critical to achieving good results, but with a great team dynamic, there’s no telling what you can achieve. It’s a thing of beauty!

Take the case of Blake Kruger, David de Gijsel, Dema Hakim, and Sarah Moore, four students in Dartmouth Institute’s residential MPH program who met in PH 100: Inferential Methods and Systematic Review. Students in the course learn to recognize the strengths and weaknesses of various study designs. They then develop a research question of their own, and, after conducting a preliminary literature search, submit a proposal for conducting a systematic review.

“Students need to find a topic on which there are enough studies available (to do a meta-analysis) and one in which the question hasn’t already been sufficiently answered,” says Assistant Professor Natalie Riblet, MD, MPH, who teaches the course. “It also helps if it’s a topic they feel passionately about because that’s often when you see the best work.”

David, an MD who is currently doing a Fellowship in Infectious Diseases, quickly teamed up with classmate Blake. As an undergrad at Louisiana State University, Blake had worked with LSU’s School of Medicine on researching new biomarkers for monitoring liver disease progression.

At first, the two were interested in looking at questions around the cost and efficacy of new drugs to treat Hepatitis C. With David’s clinical background and Blake’s background in physical chemistry, they had a strong foundation from which to investigate and analyze this research area. However, the pair soon realized that questions on these topics had been sufficiently investigated.

They then homed in on telemedicine and Hepatitis C treatment as a topic on which there was still room for meaningful investigation. 

The question they ultimately developed was: “In people with chronic HCV (Hepatitis C) infection who live and seek care in a rural setting, do telemedicine initiatives improve the rate of SVR (sustained virologic response) as compared to usual care?”

Part 2: Dema and Sarah

During the fall term, in PH 102: Inferential Methods and Systematic Review, Part 2, students get step-by-step instruction on conducting and communicating the findings of a systematic review. At the end of the class, they present their findings in a poster session and a final manuscript, which means logging a lot of hours identifying and critically appraising the peer-reviewed literature on their chosen topic. 

That’s when Dema and Sarah joined Blake and David on the “Telemedicine for Hepatitis C” team. They each brought something to the group dynamic that complemented David’s clinical background and Blake’s in chemistry and infectious disease research. Dema works as clinical research coordinator and network site coordinator for the Lurie Center for Autism at Massachusetts General Hospital for Children, which has utilized telemedicine, as well as the ECHO hub-and-spoke model developed at the University of New Mexico to treat patients with autism. Before enrolling in the MPH program, Sarah worked as an account manager in provider relations at American Well, a Boston-based telehealth services company.

“All of us filled in unique roles,” David says. “While I had clinical experience, Dema had experience with design implementation, and Sarah had strong project management skills, as well as exposure to various aspects of the commercial payer and provider reimbursement landscape.”

“It was a pleasant surprise academically being in each other’s presence,” Sarah added. “There was an amazing balance. We got into a real flow where each assignment was a total team effort that relied on the strengths of each person.”

After conducting their review and meta-analysis the group concluded that in areas with limited access to specialists, the use of telemedicine is as effective as usual care in the treatment of Hepatitis C.

“Basically, if you live in rural New Hampshire and you are treated by a doctor or nurse who uses telemedicine your odds of getting cured are the same as if you decided to travel all the way to Dartmouth-Hitchcock to get treated,” Blake says.

However, David questions whether the evolution of drugs used to treat Hepatitis C may have abolished the need for telemedicine. “Hep C treatments used to be quite burdensome with lots of side effects, but now they’ve become very safe and easy to administer in a general practice, so the question becomes do you really still need telemedicine,” he says. “However, there may be some primary care practitioners who may not be comfortable treating something they haven’t before.”

Although David plans to return to clinical practice himself after completing his MPH, he says he appreciates the “powerful experiential learning” this class afforded him and hopes the team will eventually be able to publish their findings. (While publishing isn’t expected, several research teams in previous years who have been able to publish their findings, Riblet says.)

 Dema, who plans on being involved with research throughout her career, says her experience in the course was very valuable. “Systematic reviews are so important because It’s not always feasible to do your own research. You have to be confident in your ability to evaluate the work of other researchers,” she says.

While the course content was valuable, Dema also says the experience of working in a “dream team” was invaluable. “To see how people of different ages from different backgrounds and different parts of the world could come together and work seamlessly was an experience I’ll never forget,” she says.
 

POSTED 3/21/2018 AT 10:36 AM IN #Primary Care Practice #Master of Public Health (Accelerated On-Campus and Online) #home #infectious diseases #Hepatitis C #telemedicine #telehealth #team #teamwork #publichealth #graduate education