Article

Importance of Patient, Provider, and Facility Predictors of Hepatitis C Virus Treatment in Veterans: A National Study

Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
The American Journal of Gastroenterology (Impact Factor: 10.76). 11/2010; 106(3):483-91. DOI: 10.1038/ajg.2010.430
Source: PubMed

ABSTRACT

Several patient characteristics are known to impact hepatitis C virus (HCV) antiviral treatment rates. However, it is unclear whether, and to what extent, health-care providers or facility characteristics impact HCV treatment rates.
Using national data obtained from the Department of Veterans Affairs (VA) HCV Clinical Case Registry, we conducted a retrospective cohort study of patients with active HCV viremia, who were diagnosed between 2003 and 2004. We evaluated patient-, provider-, and facility-level predictors of receipt of HCV treatment with hierarchical logistic regression.
The overall HCV treatment rate in 29,695 patients was 14.2%. The strongest independent predictor for receipt of treatment was consultation with an HCV specialist (odds ratio=9.34; 8.03-10.87). Patients were less likely to receive HCV treatment if they were Black, older, male, current users of alcohol or drugs, had HCV genotype 1 or 4, had higher creatinine levels, or had severe anxiety/post-traumatic stress disorder or depression. Patients with high hemoglobin levels, cirrhosis, and persistently high liver enzyme levels were more likely to receive treatment. Patient, provider, and facility factors explained 15, 4, and 4%, respectively, of the variation in treatment rates.
Treatment rates for HCV are low in the VA. In addition to several important patient-level characteristics, a specialist consultant has a vital role in determining whether a patient should receive HCV treatment. These findings support the development of patient-level interventions targeted at identifying and managing comorbidities and contraindications and fostering greater involvement of specialists in the care of HCV.

1 Follower
 · 
28 Reads
  • Source
    • "In patients with a history of substance abuse, the healthcare reality of hepatitis C treatment is that only a minority are treated (Grebely et al., 2008; Mehta et al., 2008); the reasons for not receiving treatment are many, but three of them stand out: risk of poor therapeutic compliance, risk of reinfection and risk of exacerbation of psychiatric comorbidity (Edlin, 2002; Kramer et al., 2011). At the care level there are still other barriers to access treatment for chronic hepatitis C, such as the lack of care contexts for the treatment of this population or the insufficient clinical training in the management of liver disease and substance abuse (Grebely & Tyndall, 2011; Litwin et al., 2007; Reimer & Haasen, 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: With 3-4 million of new infections occurring annually, hepatitis C virus (HCV) infection is a global Public Health problem. In fact, hepatitis C virus infection is one of the leading causes of liver disease in the world; in Western countries, two thirds of the new HCV infections are associated with injection drug use.The treatment of hepatitis C will change in the coming years with the irruption of new anti-HCV drugs, the so called Direct Antiviral Agents (DAA) that attack key proteins of the HCV life cycle. The new antiviral drugs are effective, safer and better tolerated. The 2014 WHO HCV treatment guidelines include some of them. The new DAA are used in combination and it is expected that Interferon will be not necessary in future treatment regimens against HCV infection.The irruption of new and potent antivirals mandate the review of the current standards of care in the HCV infected population. More inclusive and proactive treatment policies will be necessary in those individuals with substance use disorders.
    Full-text · Article · Jul 2015 · Adicciones
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hepatitis C virus (HCV), a major cause of chronic liver disease, affects an estimated 5 million people in the Unites States [1] and close to 170 million people worldwide. Certain subpopulations including injection drug users, prison inmates, the homeless, ethnic minorities, American veterans, and HIV co-infected patients are considered high risk for viral acquisition and are disproportionately affected by HCV. This review describes the prevalence of HCV in these at-risk populations including those with cirrhosis, chronic kidney disease (CKD), solid organ transplantation and presents current treatment options.
    Full-text · Article · Mar 2012 · Current Hepatitis Reports
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Institute of Medicine's publications To Err Is Human and Crossing the Quality Chasm publicized the widespread deficits in health-care quality. The quality of care for digestive diseases has not been evaluated comprehensively, although emerging literature suggests that the gap between recommended care and actual practice may be quite substantial. This paper reviews the history of, the rationale behind, and current work related to quality of care and quality improvement in the area of digestive diseases, with particular attention to colonoscopy, inflammatory bowel diseases, gastroesophageal reflux disease, chronic hepatitis C virus infection, and liver transplantation.
    No preview · Article · Jul 2011 · The American Journal of Gastroenterology
Show more