2011 National Meeting

3080 — Impaired Access to Specialty Care Among Rural Veterans with Hepatitis C

Rongey CA (San Francisco VAMC) , Hamilton N (San Francisco VAMC), Asch S (West Los Angeles VAMC), Knight S (San Francisco VAMC)

Objectives:
To determine rural and urban differences in disease burden as well as access to and quality of liver related care among veteran health administration (VHA) patients with Hepatitis C (HCV).

Methods:
We conducted a national VHA data analysis using the HCV Clinical Case Registry between the years of 2005 and 2009. We categorized patient residency as urban or rural utilizing ZIP and Rural-Urban Community Area (RUCA) codes of their most frequented primary care site. We created a cohort of patients who have had at least one VHA visit, starting in 2005 and ending in 2009. We conducted descriptive analysis noting the prevalence of HCV patients in rural and urban sites, severity of liver disease, medical co-morbidities and receipt of HCV quality of care indicators. We conducted multivariate logistic regression to determine if geographic distribution significantly predicted specialty utilization.

Results:
Between the years of 2005 and 2009, 334,058 veterans with HCV sought care in the VHA, of whom 92% and 8% reside in urban and rural areas respectively. Among the 214,042 cohort patients, the prevalence of cirrhosis is increasing in both rural (4.1% to 7.2%) and urban (5.2% to 9.7%) veterans. While the yearly percentage of patients accessing liver care is increasing, rural veterans receive less specialty care (2005 to 2009): 15% to 35% among rural veterans and 21% to 46% among urban veterans.

Implications:
While the burden of liver disease is rising in both urban and rural populations, rural VHA patients are less likely to access a specialist. Less than half of both populations have accessed a specialist or received HCV quality of care indicators such as vaccinations and HIV testing.

Impacts:
The receipt of liver care is low in both urban and rural VHA patients. Rural veterans are particularly vulnerable to urbanization of specialty care and may not be receiving appropriate therapy. As new HCV therapies are expected by 2011, and the prevalence of cirrhosis is increasing, the need for liver care is rising. Our results support development of healthcare models which improve access to and quality of specialty care among rural and urban poor veterans.