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Frequency of and Factors Associated with Receipt of Liver-Related Specialty Care Among Patients with Hepatitis C in the Chronic Hepatitis Cohort Study

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Abstract

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.

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Acknowledgments

This study and the Chronic Hepatitis Cohort Study were funded by the CDC Foundation, which received grants from AbbVie, Gilead Sciences, and Janssen Pharmaceuticals, Inc. Past funders include Genentech, A Member of the Roche Group, and Vertex Pharmaceuticals. Past partial funders include Bristol-Myers Squibb. Granting corporations did not have access to CHeCS data and did not contribute to data analysis or writing of manuscripts.

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Authors and Affiliations

  1. Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA

    Monique A. Foster, Jian Xing, Anne C. Moorman, Fujie Xu, Scott D. Holmberg & Philip R. Spradling

  2. Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17866, USA

    Joseph Boscarino

  3. Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA

    Stuart C. Gordon, Mei Lu & Loralee Rupp

  4. Kaiser Permanente Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA

    Mark A. Schmidt

  5. Kaiser Permanente Health Research, 501 Alakawa Street, Suite 201, Honolulu, HI, 96817, USA

    Connie M. Trinacty

Authors
  1. Monique A. Foster
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  2. Jian Xing
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  3. Anne C. Moorman
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  4. Joseph Boscarino
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  5. Stuart C. Gordon
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  6. Mei Lu
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  7. Loralee Rupp
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  8. Mark A. Schmidt
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  9. Connie M. Trinacty
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  10. Fujie Xu
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  11. Scott D. Holmberg
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  12. Philip R. Spradling
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Corresponding author

Correspondence to Monique A. Foster.

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Foster, M.A., Xing, J., Moorman, A.C. et al. Frequency of and Factors Associated with Receipt of Liver-Related Specialty Care Among Patients with Hepatitis C in the Chronic Hepatitis Cohort Study. Dig Dis Sci 61, 3469–3477 (2016). https://doi.org/10.1007/s10620-016-4269-0

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  • DOI: https://doi.org/10.1007/s10620-016-4269-0

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