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Barriers to the treatment of hepatitis C

Patient, provider, and system factors

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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.

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Authors and Affiliations

  1. General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    James A. Morrill MD, PhD & Richard W. Grant MD, MPH

  2. VIGH Charlestown HealthCare Center, Charlestown, MA, USA

    James A. Morrill MD, PhD

  3. MGH Revere HealthCare Center, Revere, MA, USA

    Melissa Shrestha BS, CHES

Authors
  1. James A. Morrill MD, PhD
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  2. Melissa Shrestha BS, CHES
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  3. Richard W. Grant MD, MPH
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Corresponding author

Correspondence to James A. Morrill MD, PhD.

Additional information

The authors have no conflicts of interest to declare for this article or this research.

This work was supported by the Massachusetts General Hospital Clinical Research Program and by MGH Community Health Associates.

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Morrill, J.A., Shrestha, M. & Grant, R.W. Barriers to the treatment of hepatitis C. J Gen Intern Med 20, 754–758 (2005). https://doi.org/10.1111/j.1525-1497.2005.0161.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0161.x

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