Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK.
J Viral Hepat. 2010 Oct;17(10):698-704. doi: 10.1111/j.1365-2893.2009.01227.x.
Infection with the hepatitis C virus commonly occurs in patient groups who have difficulty accessing conventional medical care, reducing their chance of successful antiviral therapy. Managed care networks (MCNs) have been suggested as a mechanism of improving access to care; however, there is little evidence to support their use in patients with hepatitis C. The aim of this study was to evaluate the impact of a MCN for patients with hepatitis C. This was a retrospective cohort study of all individuals in our area who had received a positive hepatitis C antibody test between August 1994 and June 2008. The MCN introduced a new referral pathway, which included nonmedical referrals and outreach nurse-led clinics. These interventions were introduced in 2004 and evaluated in 2008. After the introduction of the MCN, the proportion of individuals who accessed care increased from 61% (280/430) to 82.4% (721/875). There was an increase in nonmedical referrals with 81 (18.3%) being directly referred from Drug Problem Services and 75 (17%) from the Prison Service. The changes to referral did not have a negative impact on treatment outcomes as the number who completed treatment increased from 66.1% (43/65) to 73.7% (98/133) and the sustained virological response increased from 50.7% (33/65) to 60.9% (81/133). This study provides evidence that the collaboration of health care professionals within a network can have a radical effect in improving access to care in a traditionally hard to reach population. This has been achieved with little additional resource, but rather working smarter with existing staff.
丙型肝炎病毒感染常见于难以获得常规医疗护理的患者群体，降低了他们接受成功抗病毒治疗的机会。管理式医疗网络（MCN）被认为是改善医疗服务可及性的一种机制；然而，几乎没有证据支持它们在丙型肝炎患者中的应用。本研究旨在评估 MCN 对丙型肝炎患者的影响。这是一项对我们地区所有在 1994 年 8 月至 2008 年 6 月期间接受丙型肝炎抗体检测呈阳性的个体进行的回顾性队列研究。MCN 引入了一种新的转诊途径，包括非医疗转诊和外展护士主导的诊所。这些干预措施于 2004 年引入，并于 2008 年进行了评估。在 MCN 引入后，获得医疗服务的个体比例从 61%（280/430）增加到 82.4%（721/875）。非医疗转诊有所增加，其中 81 人（18.3%）直接从毒品问题服务处转诊，75 人（17%）从监狱服务处转诊。转诊方式的改变并没有对治疗结果产生负面影响，因为完成治疗的人数从 66.1%（43/65）增加到 73.7%（98/133），持续病毒学应答率从 50.7%（33/65）增加到 60.9%（81/133）。本研究提供了证据表明，网络内医疗保健专业人员的合作可以对改善传统上难以接触到的人群的医疗服务可及性产生重大影响。这是在几乎没有额外资源的情况下实现的，而是通过更聪明地利用现有员工来实现的。
