Linkage to specialty care in the hepatitis C care cascade.
hepatitis C
primary health care
Journal
Journal of investigative medicine : the official publication of the American Federation for Clinical Research
ISSN: 1708-8267
Titre abrégé: J Investig Med
Pays: England
ID NLM: 9501229
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
accepted:
27
10
2020
pubmed:
19
11
2020
medline:
2
2
2022
entrez:
18
11
2020
Statut:
ppublish
Résumé
Quality gaps exist in the hepatitis C virus (HCV) care process from diagnosis to cure. To better understand current gaps and to identify targets for quality improvement, we constructed an HCV care cascade in a patient-centered medical home (PCMH) with an emphasis on the specialty referral process. We performed a retrospective study of HCV-infected patients in a PCMH using electronic health record (EPIC) data. Patients with a first positive HCV RNA between 2012 and 2019 were included. With an adaptation to analyze linkage to specialty care, we created an HCV care cascade that included the following: (1) a positive HCV RNA, (2) referral to a specialty provider, (3) a scheduled specialty appointment, (4) attendance at a specialty visit, (5) prescription for HCV therapy, and (6) evidence of sustained virological response (SVR). Patient and referring clinician characteristics were analyzed at each step of the care pathway, and the proportion of patients completing each step was calculated. Of the 256 HCV RNA-positive patients, 229 (89.5%) received a specialty referral; 215 (84.0%) had an appointment scheduled; 178 (69.5%) attended the specialty appointment; 116 (45.3%) were prescribed antiviral therapy; and 87 (34.1%) had documented SVR during the study period. Of the 178 patients attending a specialty visit, 62 (34.8%) did not receive a prescription, and the barrier most often noted was the desire for further workup (40.3%). Gaps occur at all stages of the HCV care continuum, with drop-offs in care occurring both before and after linkage to specialty care.
Identifiants
pubmed: 33203787
pii: jim-2020-001521
doi: 10.1136/jim-2020-001521
pmc: PMC7863626
mid: NIHMS1661293
doi:
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
324-332Subventions
Organisme : NIDDK NIH HHS
ID : K23 DK118200
Pays : United States
Organisme : NIGMS NIH HHS
ID : P20 GM130457
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK123704
Pays : United States
Informations de copyright
© American Federation for Medical Research 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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