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Primary Care and Hepatology Provider–Perceived Barriers to and Facilitators of Hepatitis C Treatment Candidacy and Adherence

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Abstract

Background

Provider perceptions regarding barriers to and facilitators of hepatitis C (HCV) treatment initiation and adherence have not been fully evaluated in the interferon-free treatment era. New treatments have provided opportunities for non-specialists to treat HCV, underscoring the importance of understanding primary care provider (PCP) and specialist perspectives.

Methods

Based on qualitative sampling principles, 12 PCPs and 12 hepatology providers (HPs) from the VA Pittsburgh Healthcare System completed audio-recorded semi-structured interviews. Qualitative analysts coded perceived barriers and facilitators from the interviews with 100% double coding. Codes were thematized and analyzed using Atlas.ti.

Results

Key barriers to treatment described by HPs and PCPs included patients’ substance use disorders, mental health, transportation availability, history of non-adherence, and concern about side effects. PCPs also focused on medication cost as a system-based barrier. The main facilitators of treatment initiation and adherence described by both HPs and PCPs were provider education and encouragement. HPs focused almost exclusively on provider-based facilitators, while PCPs noted patient-based facilitators including past adherence, media exposure to information about HCV medications, a desire to clear the virus, and positive feedback regarding treatment response.

Conclusions

Providers generally focused on perceived patient-level barriers to HCV treatment initiation and adherence, as well as provider-level facilitators; PCPs additionally noted patient preferences and system-level issues that guide decision making regarding treatment initiation. While HPs focused almost exclusively on provider-level facilitators, PCPs additionally focused on patient-level facilitators of treatment. These data provide novel insights and suggest focusing on patient, provider, and system-level strategies to further improve HCV treatment initiation and adherence.

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Acknowledgments

This research was sponsored by an investigator-initiated grant from Gilead Sciences to the institution. Dr. Zickmund’s salary was supported by this grant and by VA HSR&D IDEAS 2.0 COIN grant number 150HX001240.

Author information

Authors and Affiliations

  1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA

    Shari S. Rogal & Susan L. Zickmund

  2. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Cube 2-24, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA

    Rory McCarthy

  3. Gastroenterology, Hepatology, and Nutrition Section, Washington DC VA Medical Center, 50 Irving Street, NW, Room 3A-149, Washington, DC, 20422, USA

    Andrea Reid

  4. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A127, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA

    Keri L. Rodriguez

  5. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Cube 2-18, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA

    Linda Calgaro

  6. Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite W933, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Keri L. Rodriguez & Krupa Patel

  7. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Cube G-18, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA

    Molly Daley

  8. Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, 3471 Fifth Avenue, 900 Kaufmann Building, Pittsburgh, PA, 15213, USA

    Shari S. Rogal & Naudia L. Jonassaint

  9. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Shari S. Rogal & Naudia L. Jonassaint

  10. VA HSR&D IDEAS 2.0 Center of Innovation, VA Salt Lake City Heath Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA

    Susan L. Zickmund

  11. Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA

    Susan L. Zickmund

Authors
  1. Shari S. Rogal
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  2. Rory McCarthy
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  3. Andrea Reid
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  9. Susan L. Zickmund
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Correspondence to Shari S. Rogal.

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Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

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Rogal, S.S., McCarthy, R., Reid, A. et al. Primary Care and Hepatology Provider–Perceived Barriers to and Facilitators of Hepatitis C Treatment Candidacy and Adherence. Dig Dis Sci 62, 1933–1943 (2017). https://doi.org/10.1007/s10620-017-4608-9

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  • DOI: https://doi.org/10.1007/s10620-017-4608-9

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