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Guideline-concordant hepatitis C virus testing and notification among patients with and without mental disorders.

Kilbourne AM, McCarthy JF, Himelhoch S, Welsh D, Hauser P, Blow FC. Guideline-concordant hepatitis C virus testing and notification among patients with and without mental disorders. General hospital psychiatry. 2008 Nov 1; 30(6):495-500.

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Abstract:

OBJECTIVE: We compared screening for hepatitis C virus (HCV), positive HCV test rates and test result notification among Veterans Affairs (VA) patients diagnosed with psychosis (e.g., schizophrenia, bipolar disorder) or depression or those with no psychiatric diagnosis. METHOD: We identified all patients in the VA's External Peer Review Program national random sample of chart reviews regarding HCV care in fiscal year 2004. We then identified individuals diagnosed with psychosis or depression using data from the VA's National Psychosis and Depression registries. Using multivariable logistic regression and generalized estimating equation analyses, we evaluated associations between mental disorder diagnosis and receipt of HCV screening and notification of results. RESULTS: Out of 19,397 patients, 94% received HCV tests. Of those tested, 6.9% were HCV positive, and of those who were positive, 48.2% were notified of their result within 60 days. After adjusting for demographic and clinical factors (including illicit drug use and comorbidities), individuals with psychosis or depression were no less likely to have a positive test or be notified of their result < or = 60 days compared to nonpsychiatric groups. Those with drug use disorder diagnoses (OR = 4.64; P < .001) and Blacks (OR = 1.96; P < .001) were more likely to have a positive test. CONCLUSIONS: Study limitations included inability to fully control for sociodemographic confounders (e.g., homelessness, incarceration). Nevertheless, we found that although the vast majority of patients were tested, only half were notified of test results. VA HCV prevention and follow-up strategies focus on enhanced notification overall and tailoring HCV risk reduction programs to minorities and those with drug use disorders.





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