Management of Patients With Hepatitis C in a Community Population: Diagnosis, Discussions, and Decisions to Treat

Abstract

BACKGROUND Chronic hepatitis C, a treatable condition caused by the hepatitis C virus (HCV), can be found in almost all primary care and community practices. The rate of hepatitis C treatment is low, however. This study explores the frequency of hepatitis C treatment, documented discussions of treatment consideration, and the reasons treatment may not be offered in a community population. METHODSThis study is a retrospective medical record review of care provided to all patients in Olmsted County, Minn, who had a confi rmed diagnosis of hepatitis C. Using all records from all health care providers in Olmsted County, the rates of documented discussions regarding hepatitis C treatment and the treatment rates by specialty of diagnosing physician were assessed. In addition, comorbidities listed as reasons not to treat and or comorbid conditions in patients without a documented treatment discussion were assessed. RESULTSOf the 366 patients with hepatitis C, 62% were men. Hepatitis C was more commonly diagnosed by generalist physicians (41% of cases). Treatment discussions were documented for 77% of patients with hepatitis C diagnosed by either a generalist or a gastrointestinal specialist (gastroenterologist or hepatologist) compared with 46% of patients with hepatitis C diagnosed by other physicians. Generalists' patients were more likely to have documented contraindications to treatment and were only one half as likely to receive hepatitis C treatment compared with patients with hepatitis C diagnosed by gastrointestinal specialists (16% vs 33%). Documented attempts to treat or reassess after resolution of potentially reversible contraindications to hepatitis C therapy were infrequent. CONCLUSIONSIn this community population, hepatitis C treatment was discussed with the majority of patients with a diagnosis of hepatitis C; however, the actual treatment rate was low. Many opportunities exist for treating more patients for HCV infection, particularly those found during emergency care and chemical dependency treatment. In addition, generalists' recognition and treatment of potentially reversible contraindications to hepatitis C therapy could greatly increase the number of treatment candidates.

Hepatitis C infection: eligibility for antiviral therapies

“…Rowan et al [13] in a series of 580 Veterans, and Muir and Provenzale [12] in a series of 100 Veterans, showed that 70% and 68%, respectively, of their HCV patients had not been considered as eligible for therapy. Rocca et al [17] retrospectively reviewed a series of 366 HCV patients listed in the Olmsted County Hepatitis C registry. For these patients, a discussion on treatment was performed for only 234 patients (64%).…”

“…In this population, the most common contraindication was psychosocial factors [12]. Although the findings in HCV-infected US Veterans may not be directly applicable to other HCV populations (because they are more likely than HCV-infected US non-Veterans to have a history of alcoholism, active substance abuse, posttraumatic stress disorder and antidepressant therapy [14]), a few studies in the general population in the United States also reported that many patients were not eligible for therapy [15][16][17]. To date, such figures are not available for Europe.…”

The Future of Family Medicine? Reflections from the Front Lines Reveal Frustration and Opportunity

“…The study of management of hepatitis C patients 19 brought calls for advocacy and safety nets to facilitate care 20,21 and useful additional clinical information for increasing our awareness and effi cacy in case fi nding in primary care. 22,23 The study of medical errors by Elder et al 23 spawned a research agenda 24 and an articulation of the challenges of measuring errors of omission.…”

The Use of Telemedicine for the Management of Hepatitis C & the California Telehealth Network

“…Prior studies have shown that HCV patients without access to a specialist are less likely to be treated (Rocca et al, 2004). This is significant from a clinical and public health standpoint because almost half of patients treated with the current standard of care (6-18 months of therapy with pegylated interferons and ribavirin) achieve long term cure with a resultant improvement of liver-related mortality rate that approximates the one experienced in the general population (Simin et al, 2007;Veldt et al, 2007;Kasahara et al, 2004).…”