Frequency of and Factors Associated with Receipt of Liver-Related Specialty Care Among Patients with Hepatitis C in the Chronic Hepatitis Cohort Study
Foster MA, Xing J, Moorman AC, Boscarino J, Gordon SC, Lu M, Rupp LB, Schmidt MA, Trinacty CM, Xu F, Holmberg SD, Spradling PR. Frequency of and Factors Associated with Receipt of Liver-Related Specialty Care Among Patients with Hepatitis C in the Chronic Hepatitis Cohort Study. Digestive Diseases and Sciences 2016; 61(12):3469-3477.
Digestive Diseases and Sciences
BACKGROUND: Linking persons with hepatitis C virus (HCV) to care and treatment is critical to reduction in disease burden; typically, this entailed referral to a specialist. However, data regarding the frequency and factors associated with referral among patients in healthcare organizations (HCOs) are lacking.
METHODS: Among persons in four US HCOs with newly diagnosed HCV during 2006-2011, we determined the frequency of liver-related specialist care after diagnosis. We also identified sociodemographic and clinical characteristics associated with such care by multivariate analysis, adjusted for all variables.
RESULTS: Among 3592 patients with newly diagnosed HCV, 57 % (range among sites 45-90 %) received specialist care; of these, 57 % received care within 90 days of diagnosis. Patient characteristics associated with receipt of specialist care included: affiliation with one of the study sites [adjusted odds ratio (aOR) 4.8 vs. the referent site); having Medicare plus private insurance (aOR 1.6 vs. Medicaid); and having elevated alanine aminotransferase (ALT) (aOR 1.6 vs. normal ALT) or lower platelet values (aOR 1.4 vs. normal platelet level). Specialist care within 90 days of diagnosis was associated with private insurance (aOR 1.5 vs. Medicaid), elevated ALT levels (aOR 1.3-2.3 vs. normal), and having ≥2 comorbid conditions (aOR 1.4 vs. no comorbid conditions). Compared to patients not referred, those referred were more likely to be treated (aOR 3.5).
CONCLUSIONS: Receipt of specialist care among persons with newly diagnosed HCV varied among HCOs. Clinical evidence of liver disease and having private insurance were associated with prompt receipt of specialist care and HCV treatment.
Medical Subject Headings
Adolescent; Adult; Aged; Alanine Transaminase; Antiviral Agents; Cohort Studies; Comorbidity; Disease Management; Female; Gastroenterology; Hepatitis C, Chronic; Humans; Insurance, Health; Male; Medicaid; Medicare; Medicine; Middle Aged; Multivariate Analysis; Odds Ratio; Platelet Count; Referral and Consultation; Time Factors; United States; Young Adult