Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model

Sherbuk, Jacqueline E.; McManus, Kathleen A; Knick, Terry; Canan, Chelsea E.; Flickinger, Tabor; Dillingham, Rebecca

doi:10.3389/fpubh.2019.00362

Cited by 17 publications

(26 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study took place at the University of Virginia (UVA) Infectious Diseases HCV clinic which employs a nurse-navigator model of HCV care, previously described in detail (8). The study population was defined to be all patients ages 18 years and older referred to the HCV clinic between November 2014 and March 2018 who failed to link to care.…”

Section: Study Design and Study Populationmentioning

confidence: 99%

“…To connect diagnosed patients to HCV specialty care, linkage to care (LTC) programs including nurse-driven care, intensive case management, and peer support have been implemented (7). In our HCV referral clinic, implementation of a nurse navigator model has led to a 76% LTC rate (8). Yet even in this model of patient education and intensive care coordination, nearly a quarter of patients failed to link to care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patient perceptions of Hepatitis C among those failing to pursue treatment: A qualitative study of barriers and facilitators to care

Sherbuk¹,

Tabackman²,

McManus³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Most people diagnosed with Hepatitis C virus (HCV) have not linked to care. The patient perspective on decision-making regarding linkage to care (LTC) in the direct acting antivirals treatment era is limited. We assess perceptions that impacted the choice not to pursue care among non-urban patients in the South who failed to attend an HCV clinic appointment. Methods We conducted a demographic survey and semi-structured interview with participants referred to our HCV clinic between 2014 and 2018 who did not attend an appointment. Data collection and analyses were guided by the Health Belief Model. Results Twelve participants enrolled, including 7 men and 5 women. Barriers to care were common including being uninsured (33%), having unreliable transportation (42%), unstable housing (33%), and a history of substance use disorder requiring treatment (58%). Participants demonstrated good knowledge of HCV disease, complications, and treatment. Emerging themes regarding failure of LTC included: (1) ambivalence due to uncertainty regarding the impact of HCV on one’s own health, (2) logistical barriers such as financial concerns, lack of insurance, transportation, scheduling conflicts, (3) prior negative experiences with HCV care resulting in hesitance to seek care, (4) stigma, and (5) patient-provider relationships as a barrier when the relationship is poor and a facilitator when good. Conclusions A strong HCV knowledge base was not sufficient for participants to seek care. Strategies to increase treatment uptake by changing patient perceptions include addressing the uncertainty of how HCV impacts one’s health, acknowledging challenges with HCV treatment in the past, eliminating stigma in health care settings, and promoting education regarding treatment ease and availability. Expanding access to Medicaid may overcome perceived financial barriers. Providing HCV care in settings with an established patient-provider relationship may increase treatment uptake.

show abstract

Section: Study Design and Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient perceptions of Hepatitis C among those failing to pursue treatment: A qualitative study of barriers and facilitators to care

Sherbuk¹,

Tabackman²,

McManus³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Two visits are required to receive treatment: (1) a provider visit, and (2) imaging for staging of liver disease. Through insurance coverage, with co-pay assistance if needed, and patient assistance programs, the nurse coordinator has been able to obtain medications for all eligible patients during the study time period (17).…”

Section: Clinical Settingmentioning

confidence: 99%

“…States, implementation of a nurse navigator model led to a 76% LTC rate (17). Yet even in this highintensity outreach model of patient education and care coordination, nearly a quarter of patients did not see a specialty provider at least 6 months following referral.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

Sherbuk

Tabackman

McManus

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Most people diagnosed with Hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban southern United States. Methods We conducted a demographic survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify the key factors influencing patient perceptions regarding HCV and pursuit of care. Results Over half of previously referred patients could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Common barriers to care included being uninsured (n = 4), having unreliable transportation (n = 5), unstable housing (n = 4), and drug use in the past year (n = 5). Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one’s own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care. Conclusions Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.

show abstract

“…Varied models of care have been implemented to improve LTC, including nurse-driven care, case management, and peer support [16]. In our HCV referral clinic in the non-urban Southern United States, implementation of a nurse navigator model led to a 76% LTC rate [17]. Yet even in this high-intensity outreach model of patient education and care coordination, nearly a quarter of patients did not see a specialty provider at least 6 months following referral.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Most people diagnosed with hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban Southern United States. Methods We conducted a survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify key factors influencing patient perceptions regarding HCV and pursuit of care. Results Over half of previously referred patients (N = 200) could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Based on survey responses, unreliable transportation, unstable housing, substance use, and lack of insurance were common. Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis of semi-structured interviews, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one’s own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care. Conclusions Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.

show abstract

Disparities in Hepatitis C Linkage to Care in the Direct Acting Antiviral Era: Findings From a Referral Clinic With an Embedded Nurse Navigator Model

Cited by 17 publications

References 31 publications

Patient perceptions of Hepatitis C among those failing to pursue treatment: A qualitative study of barriers and facilitators to care

Patient perceptions of Hepatitis C among those failing to pursue treatment: A qualitative study of barriers and facilitators to care

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South

Contact Info

Product

Resources

About