Department of Medicine and The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
Telemed J E Health. 2021 May;27(5):488-494. doi: 10.1089/tmj.2020.0090. Epub 2020 Sep 2.
Expanding access to direct-acting antiviral agents (DAAs) for treating hepatitis C virus (HCV) infection is the national goal for HCV elimination, but important urban-rural disparities exist in DAA use. Evidence is needed to evaluate intervention efforts to reduce urban-rural disparities in DAA utilization. We used Medicare data to compare DAA use between urban HCV patients and rural HCV patients in two states: State A with a telementoring approach to train rural providers to treat HCV patients and State B without such an intervention. We focused on DAA utilization among newly diagnosed HCV patients in 2014-2016 and defined DAA use as filling at least one prescription of DAAs during 2014-2017. We classified patient's urban-rural status based on their ZIP code of residence. We assessed overtime changes in urban-rural disparities in DAA utilization for each state using multivariable cause-specific Cox regression analyses with time-varying hazard ratios. Among 1,872 new HCV patients in State A, 135 (17.00%) rural patients and 243 (22.54%) urban patients received DAAs in 2014-2017. Although there was noticeable urban-rural disparities in DAA use during the first 24 months of follow-up (hazard ratios [HRs] = 0.73 [0.51 to 1.03] for 0-12 months and 0.61 [0.39 to 0.95] for 13-24 months), the disparities became nonsignificant afterward (HR = 1.06 [0.58 to 1.93] after 24 months). Most DAA users in rural areas (94, 70%) in State A received DAAs prescribed by primary care providers (PCPs). In State B, among 8,928 new HCV patients, 227 (18.22%) rural patients and 1,600 (20.83%) urban patients received DAAs in 2014-2017. Rural patients were less likely to receive DAAs over time (HR = 1.12 [0.93 to 1.36] in the first 12 months and HR = 0.62 [0.40 to 0.96] after 24 months). Only 81 (36%) DAA users in rural areas in State B were treated by PCPs. Our study suggests that the telementoring approach may help reduce urban-rural disparities in DAA utilization.
扩大直接作用抗病毒药物（DAA）在治疗丙型肝炎病毒（HCV）感染方面的可及性是 HCV 消除的国家目标，但在 DAA 使用方面存在重要的城乡差异。需要有证据来评估干预措施，以减少 DAA 使用方面的城乡差距。我们使用医疗保险数据比较了两个州（州 A 和州 B）的城市 HCV 患者和农村 HCV 患者的 DAA 使用情况：州 A 采用远程医疗方法培训农村医生治疗 HCV 患者，而州 B 则没有这种干预措施。我们主要关注 2014-2016 年新诊断的 HCV 患者的 DAA 使用情况，并将 DAA 使用定义为在 2014-2017 年期间至少开具一种 DAA 处方。我们根据患者居住地的邮政编码来确定患者的城乡身份。我们使用具有时变风险比的多变量病因特异性 Cox 回归分析，评估每个州 DAA 使用的城乡差异随时间的变化。在州 A 的 1872 名新 HCV 患者中，2014-2017 年期间，有 135 名（17.00%）农村患者和 243 名（22.54%）城市患者接受了 DAA 治疗。尽管在随访的前 24 个月中，DAA 使用存在明显的城乡差异（0-12 个月时的风险比[HR]为 0.73[0.51 至 1.03]，13-24 个月时为 0.61[0.39 至 0.95]），但之后这种差异变得不显著（24 个月后为 HR=1.06[0.58 至 1.93]）。州 A 农村地区的大多数 DAA 使用者（94 名，70%）接受了初级保健提供者（PCP）开具的 DAA。在州 B，在 8928 名新 HCV 患者中，2014-2017 年期间，有 227 名（18.22%）农村患者和 1600 名（20.83%）城市患者接受了 DAA 治疗。随着时间的推移，农村患者接受 DAA 的可能性较小（第 12 个月时的 HR 为 1.12[0.93 至 1.36]，第 24 个月时的 HR 为 0.62[0.40 至 0.96]）。州 B 农村地区仅有 81 名（36%）DAA 使用者接受了 PCP 治疗。我们的研究表明，远程医疗方法可能有助于减少 DAA 使用方面的城乡差距。
