Barriers to the treatment of hepatitis C

Patient, provider, and system factors
  • James A. Morrill
  • Melissa Shrestha
  • Richard W. Grant
Original Articles

Abstract

BACKGROUND: Hepatitis C virus (HCV) infection is both prevalent and undertreated.

OBJECTIVE: To identify barriers to HCV treatment in primary care practice.

DESIGN: Cross-sectional study.

SETTING AND PARTICIPANTS: A cohort of 208 HCV-infected patients under the care of a primary care physician (PCP) between December 2001 and April 2004 at a single academically affiliated community health center.

MEASUREMENTS: Data were collected from the electronic medical record (EMR), the hospital clinical data repository, and interviews with PCPs.

MAIN RESULTS: Our cohort consisted of 208 viremic patients with HCV infection. The mean age was 47.6 (±9.7) years, 56% were male, and 79% were white. Fifty-seven patients (27.4% of the cohort) had undergone HCV treatment. Independent predictors of not being treated included: unmarried status (adjusted odds ratio [aOR] for treatment 0.36, P=.02), female gender (aOR 0.31, P=.01), current alcohol abuse (aOR 0.08, P=.0008), and a higher ratio of no-shows to total visits (aOR 0.005 per change of 1.0 in the ratio of no-shows to total visits, P=.002). The major PCP-identified reasons not to treat included: substance abuse (22.5%), patient preference (16%), psychiatric comorbidity (15%), and a delay in specialist input (12%). For 13% of the untreated patients, no reason was identified.

CONCLUSIONS: HCV treatment was infrequent in our cohort of outpatients. Barriers to treatment included patient factors (patient preference, alcohol use, missed appointments), provider factors (reluctance to treat past substance abusers), and system factors (referral-associated delays). Multimodal interventions may be required to increase HCV treatment rates.

Key words

hepatitis C virus infection interferon and ribavirin therapy barriers to treatment substance abuse 

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • James A. Morrill
    • 1
    • 2
  • Melissa Shrestha
    • 3
  • Richard W. Grant
    • 1
  1. 1.General Medicine Division, Department of MedicineMassachusetts General HospitalBostonUSA
  2. 2.VIGH Charlestown HealthCare CenterCharlestownUSA
  3. 3.MGH Revere HealthCare CenterRevereUSA
  4. 4.Adult Medicine UnitMGH Charlestown HealthCare CenterCharlestown

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