Health Disparities in Hepatitis C Screening and Linkage to Care at an Integrated Health System in Southeast Michigan

Abstract

With recommended screening for hepatitis C among the 1945–1965 birth cohort and advent of novel highly effective therapies, little is known about health disparities in the Hepatitis C care cascade. Our objective was to evaluate hepatitis C screening rates and linkage to care, among patients who test positive, at our large integrated health system. We used electronic medical records to retrospectively identify patients, in the birth cohort, who were seen in 21 Internal Medicine clinics from July 2014 to June 2015. Patients previously screened for hepatitis C and those with established disease were excluded. We studied patients’ sociodemographic and medical conditions along with provider-specific factors associated with likelihood of screening. Patients who tested positive for HCV antibody were reviewed to assess appropriate linkage to care and treatment. Of 40,561 patients who met inclusion criteria, 21.3% (8657) were screened, 1.3% (109) tested positive, and 30% (30/100) completed treatment. Multivariate logistic regression showed that African American race, male gender, electronic health engagement, residency teaching clinic visit, and having more than one clinic visit were associated with higher odds of screening. Patients had a significant decrease in the likelihood of screening with sequential interval increase in their Charlson comorbidity index. When evaluating hepatitis C treatment in patients who screened positive, electronic health engagement was associated with higher odds of treatment whereas Medicaid insurance was associated with significantly lower odds. This study shows that hepatitis C screening rates and linkage to care continue to be suboptimal with a significant impact of multiple sociodemographic and insurance factors. Electronic health engagement emerges as a tool in linking patients to the hepatitis C care cascade.

Impact of electronic reminder systems on hepatitis C screening in primary care

“…This is in contrast to emergency department settings where follow‐up is more challenging. In a study from a large integrated healthcare system comprised of urban and suburban primary care offices (in which EMR prompts were not in place), fewer than 50% of newly diagnosed baby boomers were seen by HCV specialists . Information about linkage to care data from other studies that have examined EMR‐based testing in primary care settings is limited.…”

“…In a study from a large integrated healthcare system comprised of urban and suburban primary care offices (in which EMR prompts were not in place), fewer than 50% of newly diagnosed baby boomers were seen by HCV specialists. 7 Information about linkage to care data from other studies that have examined EMR-based testing in primary care settings is limited. In the Goel study cited above, complementing the EMR testing reminder with patient navigators led to 77% of newly diagnosed baby boomers who were seen by HCV specialists.…”

“…These recommendations were endorsed by the United States Preventive Services Task Force (USPSTF) in June 2013 . Despite this endorsement, when screening decisions are left to individual health professionals, HCV testing rates among baby boomers have remained below 25% …”

“…electronic medical records, hepatitis C, liver function test, mass screening Despite this endorsement, when screening decisions are left to individual health professionals, HCV testing rates among baby boomers have remained below 25%. [5][6][7] Since the 2012 CDC screening recommendation, various approaches to increase HCV screening among baby boomers have been reported. Rates of screening as high as 83% were achieved in an urban academic emergency department using a universal testing protocol with a patient-specific opt-out option.…”

Defining the hepatitis C cure cascade in an Urban health system using the electronic health record

“…In a recent meta‐analysis examining the US HCV treatment cascade, only 17% of the 3.5 million Americans with chronic HCV infection had liver fibrosis staged by biopsy, a proxy measure for engagement in care . Another study evaluated the HCV care cascade among 8600 baby boomers screened for HCV, and of 109 (1.3%) patients who tested positive for anti‐HCV, only 51 (49%) were evaluated by a hepatitis C specialist …”