Patients with Hepatitis C Benefit from Collaborative Care
FINDINGS:
- Collaboration between specialists and primary care physicians translates into better care for patients with chronic hepatitis C (HCV). Patients were less likely to receive any recommended care if they were being treated by specialists or generalists only, compared with being seen by both.
- In this analysis of national data (non-VA), only about 19% of patients with HCV received all recommended care. The proportion of patients who met quality indicators varied substantially. For example, most patients (79%) received a genotype test before treatment, whereas relatively few (25%) received recommended vaccinations.
- Overall, 77% of patients received primary and specialty care, 19.5% received primary without specialty care, and 2.5% received only specialty care. Patients who received only specialty care were younger and had fewer psychiatric and medical comorbidities.
- Patients seen in the Northeast or the West received higher-quality care than patients in the South, while patients seen in the Midwest received lower-quality care than patients in the South.
BACKGROUND:
Chronic hepatitis C virus (HCV) infection is the leading cause of cirrhosis, hepatocellular cancer, and death from liver disease in the United States. Medicare has proposed quality-of-care indicators for HCV infection, but the extent to which these standards are being met in practice is largely unknown. This retrospective cohort study evaluated the quality of healthcare that patients (non-Veterans) with HCV receive and the factors associated with the receipt of quality care. Using research data from one of the largest commercial health insurance carriers in the U.S. (study prohibited from naming carrier), investigators assessed quality of care in a community-based sample of patients (n=10,385) who received healthcare related to HCV infection between 1/03 and 12/06. Quality of care was based on 7 Medicare quality indicators, including hepatitis A and B vaccination, receipt of antiviral therapy, and testing for genotype and viral load. Investigators assessed the association between patient and practice characteristics and quality indicators.
LIMITATIONS:
- Data used for this study did not contain information on patient race or ethnicity.
- Some findings may reflect differential ascertainment and coding, e.g., patients with drug and alcohol use received higher-quality treatment than patients without these diagnoses.
AUTHOR/FUNDING INFORMATION:
Dr. Kanwal is part of the John Cochrane VAMC in St. Louis. Dr. Asch is co-Research Director of VA/HSR&D’s HIV/Hepatitis Quality Enhancement Research Initiative (QUERI).
Kanwal F, Schnitzler M, Bacon B, Hoang T, Buchanan P, and Asch S. Quality of Care in Patients with Chronic Hepatitis C Virus Infection. Annals of Internal Medicine August 17, 2010;153(4):231-239.
