Background & Aims-Patients with hepatitis C virus (HCV) infection are at risk for developing additional liver disorders that are costly to treat and have high rates of morbidity, although the actual prevalence of these diseases is not known. We examined time trends in the prevalence of cirrhosis and its related complications, such as hepatic decompensation and hepatocellular cancer (HCC).
Use of clinical reminders and provider feedback, activation, and social marketing increased the frequency of HIV testing and the number of new HIV diagnoses. These findings support a multimodal approach toward achieving the Centers for Disease Control and Prevention's goal of having every American know their HIV status as a matter of routine clinical practice.
Treatment with interferon and ribavirin is effective in patients with chronic infection with hepatitis C virus (HCV). Previous data indicate that treatment rates are suboptimal. We sought to identify patient and provider-level predictors of treatment receipt in HCV by conducting a retrospective cohort study of 5701 HCV patients in a large regional Veteran's Administration (VA) healthcare network. We also determined the degree of variation in treatment rates attributable to patient, provider, and facility factors. Three thousand seven hundred forty-three patients (65%) were seen by a specialist and 894 ( C hronic hepatitis C virus infection (HCV) is a prevalent and expensive condition affecting more than 1.3% of the U.S. population at a cost of over $700 million annually. 1-3 HCV is the leading cause of cirrhosis, hepatocellular cancer, and death of liver disease in the United States and is the primary indication for liver transplantation worldwide. 3,4 The economic burden of HCV is multiplied by the negative impact of HCV on health-related quality of life. 5 Treatment with interferon and ribavirin is effective and results not only in reducing liver disease progression, but also improving health-related quality of life among patients with sustained viral response. [6][7][8][9] Given the burden of illness, several professional societies have published evidence-based guidelines defining the best practices and standards of treatment in HCV. These include the American Association for the Study of Liver Disease, the National Institutes of Health, the American Gastroenterology Association, and the Veterans Administration (VA). 10-13 Despite these well-disseminated guidelines, recent data indicate deficits in HCV care. Several reports demonstrate that antiviral treatment rates among HCV patients are lower than 30%, generally attributed to the high prevalence of treatment contraindications. 14-18 However, even among patients otherwise eligible for treatment, the reported treatment rates range from 45% to 75%, suggesting that factors other than treatment contraindications may be important determinants of treatment receipt. [14][15][16]18 Recent studies suggest
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