The Patient-Provider Relationship Is Associated with Hepatitis C Treatment Eligibility: A Prospective Mixed-Methods Cohort Study

Abstract

Hepatitis C virus (HCV) treatment has the potential to cure the leading cause of cirrhosis and hepatocellular carcinoma. However, only those deemed eligible for treatment have the possibility of this cure. Therefore, understanding the determinants of HCV treatment eligibility is critical. Given that effective communication with and trust in healthcare providers significantly influences treatment eligibility decisions in other diseases, we aimed to understand patient-provider interactions in the HCV treatment eligibility process. This prospective cohort study was conducted in the VA Pittsburgh Healthcare System. Patients were recruited after referral for gastroenterology consultation for HCV treatment with interferon and ribavirin. Consented patients completed semi-structured interviews and validated measures of depression, substance and alcohol use, and HCV knowledge. Two coders analyzed the semi-structured interviews. Factors associated with patient eligibility for interferon-based therapy were assessed using multivariate logistic regression. Of 339 subjects included in this analysis, only 56 (16.5%) were deemed eligible for HCV therapy by gastroenterology (GI) providers. In the multivariate logistic regression, patients who were older (OR = 0.96, 95%CI = 0.92–0.99, p = .049), reported concerns about the GI provider (OR = 0.40, 95%CI = 0.10–0.87, p = 0.02) and had depression symptoms (OR = 0.32, 95%CI = 0.17–0.63, p = 0.001) were less likely to be eligible. Patients described barriers that included feeling stigmatized and poor provider interpersonal or communication skills. In conclusion, we found that patients’ perceptions of the relationship with their GI providers were associated with treatment eligibility. Establishing trust and effective communication channels between patients and providers may lower barriers to potential HCV cure.

The challenges of hepatitis C management in Iran: A qualitative study with patients

“…As such, they do not follow the specialist' advice and treatment guidelines and may decide to change physician, generating high societal costs . Establishing appropriate relationships between health‐care service providers and HCV patients can reduce the barriers to treatment and lead to the patient's trust towards them …”

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

“…The quality of these patient-provider relationships determines if they serve as barriers or facilitators to care. Positive patient-provider relationships are bene cial in HCV treatment (44,45). Multiple patients cited their trusted provider as a key source of motivation for pursuing treatment and someone they could turn to for assistance.…”

The role of stigma and trauma in hepatitis C virus treatment in veterans: Applying the common‐sense model

“…Such stereotypes may include the perception of injection drug users as being potentially violent or manipulative, or having poor motivation (van Boekel, Brouwers, Weeghel, & Garretsen, ). In the healthcare setting, stigma has taken the form of perceived blaming, disrespect, or judgmental behavior directed by clinicians (North, Devereaux, Pollio, Hong, & Jain, ; Rogal et al, ; Skeer, Ladin, Wilkins, Landy, & Stopka, ).…”

“…A veteran may be cautious about whom he or she discloses HCV status, adopting what has been referred to as a “need to know” approach, or preferring to confide only in trusted peers (Phillips & Barnes, ). Accordingly, the experience of stigma is increasingly understood to be a barrier to care among people with HCV (Miller, McNally, Wallace, & Schlichthorst, ; Rogal et al, ; Skeer et al, ).…”

“…As a result, he or she may feel that they are less deserving of treatment (Skeer et al, ), and thus avoid seeking care. And even if the veteran's illness representation is such that HCV is controllable, he or she may not be willing to seek treatment if he or she is uncertain he or she will receive appropriate and compassionate care (Rogal et al, ). Alternatively, a veteran may feel the need to prove himself or herself as one who is reliable when faced with skepticism among clinicians (Clark & Gifford, ).…”