Houston VA Health Services Research & Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
Am J Gastroenterol. 2011 Mar;106(3):483-91. doi: 10.1038/ajg.2010.430. Epub 2010 Nov 9.
Several patient characteristics are known to impact hepatitis C virus (HCV) antiviral treatment rates. However, it is unclear whether, and to what extent, health-care providers or facility characteristics impact HCV treatment rates.
Using national data obtained from the Department of Veterans Affairs (VA) HCV Clinical Case Registry, we conducted a retrospective cohort study of patients with active HCV viremia, who were diagnosed between 2003 and 2004. We evaluated patient-, provider-, and facility-level predictors of receipt of HCV treatment with hierarchical logistic regression.
The overall HCV treatment rate in 29,695 patients was 14.2%. The strongest independent predictor for receipt of treatment was consultation with an HCV specialist (odds ratio=9.34; 8.03-10.87). Patients were less likely to receive HCV treatment if they were Black, older, male, current users of alcohol or drugs, had HCV genotype 1 or 4, had higher creatinine levels, or had severe anxiety/post-traumatic stress disorder or depression. Patients with high hemoglobin levels, cirrhosis, and persistently high liver enzyme levels were more likely to receive treatment. Patient, provider, and facility factors explained 15, 4, and 4%, respectively, of the variation in treatment rates.
Treatment rates for HCV are low in the VA. In addition to several important patient-level characteristics, a specialist consultant has a vital role in determining whether a patient should receive HCV treatment. These findings support the development of patient-level interventions targeted at identifying and managing comorbidities and contraindications and fostering greater involvement of specialists in the care of HCV.
有几项患者特征已知会影响丙型肝炎病毒 (HCV) 抗病毒治疗率。然而，尚不清楚卫生保健提供者或医疗机构特征是否以及在何种程度上影响 HCV 治疗率。
我们使用从退伍军人事务部 (VA) HCV 临床病例登记处获得的全国数据，对 2003 年至 2004 年间诊断为 HCV 病毒血症活跃的患者进行了回顾性队列研究。我们使用分层逻辑回归评估了患者、提供者和医疗机构水平对 HCV 治疗的预测因素。
在 29695 例患者中，HCV 总体治疗率为 14.2%。接受治疗的最强独立预测因素是咨询 HCV 专家（优势比=9.34；8.03-10.87）。如果患者是黑人、年龄较大、男性、当前使用酒精或毒品、HCV 基因型为 1 或 4、肌酐水平较高或患有严重焦虑/创伤后应激障碍或抑郁症，则不太可能接受 HCV 治疗。血红蛋白水平较高、肝硬化和持续高肝酶水平的患者更有可能接受治疗。患者、提供者和医疗机构因素分别解释了治疗率变化的 15%、4%和 4%。
VA 中的 HCV 治疗率较低。除了一些重要的患者水平特征外，专家顾问在确定患者是否应接受 HCV 治疗方面起着至关重要的作用。这些发现支持针对识别和管理合并症和禁忌症并促进专家更多地参与 HCV 护理的患者水平干预措施的制定。
