University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.
Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite W933, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
Dig Dis Sci. 2020 May;65(5):1324-1333. doi: 10.1007/s10620-019-05877-z. Epub 2019 Oct 23.
Significant disparities in hepatitis C (HCV) treatment existed in the interferon treatment era, such that patients with mental health and substance use disorders were less likely to be treated. We aimed to evaluate whether these perceptions continue to influence HCV treatment decisions.
We e-mailed HCV providers a survey to assess their perceptions of barriers to HCV treatment adherence and initiation. We assessed the frequency of perceived barriers and willingness to initiate HCV treatment in patients with these barriers. We identified a group of providers more willing to treat patients with perceived barriers to adherence and determined the associated provider characteristics using Spearman's rho and Wilcoxon rank-sum tests.
A total of 103 providers (29%) responded to the survey. The most commonly endorsed perceived barriers to adherence were homelessness (65%), ongoing drug (58%), and ongoing alcohol use (33%). However, 90%, 68%, and 90% of providers were still willing to treat patients with these comorbidities, respectively. Ongoing drug use was the most common reason providers were never or rarely willing to initiate HCV treatment. Providers who were less willing to initiate treatment more frequently endorsed patient-related determinants of adherence, while providers who were more willing to initiate treatment more frequently endorsed provider-based barriers to adherence (e.g., communication).
Most responding providers were willing to initiate HCV treatment in all patients, despite the presence of perceived barriers to adherence or previous contraindications to interferon-based treatments. Ongoing substance use remains the most prominent influencer in the decision not to treat.
在干扰素治疗时代，丙型肝炎（HCV）治疗存在显著差异，例如，有心理健康和物质使用障碍的患者不太可能接受治疗。我们旨在评估这些看法是否继续影响 HCV 治疗决策。
我们通过电子邮件向 HCV 提供者发送了一份调查，以评估他们对 HCV 治疗依从性和启动的障碍的看法。我们评估了对患者存在这些障碍时治疗 HCV 的意愿和感知障碍的频率。我们确定了一组更愿意治疗存在感知障碍的患者的提供者，并使用 Spearman's rho 和 Wilcoxon 秩和检验确定了相关的提供者特征。
共有 103 名（29%）提供者对调查做出了回应。最常被认可的治疗依从性感知障碍是无家可归（65%）、持续吸毒（58%）和持续酗酒（33%）。然而，分别有 90%、68%和 90%的提供者仍愿意治疗患有这些合并症的患者。持续吸毒是提供者从未或很少愿意开始 HCV 治疗的最常见原因。不太愿意开始治疗的提供者更频繁地认可与患者相关的依从性决定因素，而更愿意开始治疗的提供者更频繁地认可与提供者相关的依从性障碍（例如，沟通）。
大多数有回应的提供者愿意为所有患者启动 HCV 治疗，尽管存在治疗依从性的感知障碍或先前对基于干扰素的治疗的禁忌症。持续的物质使用仍然是决定不治疗的最主要影响因素。
