Family Practice News (11.01.12)
According to Dr. Fasiha Kanwal of the Michael E. DeBakey Veterans Affairs (VA) Medical Center in Houston, Texas, and colleagues, patients with hepatitis C virus (HCV) infections are more likely to begin antiviral therapy and achieve a sustained virologic response if they already have high-quality health care. The researchers evaluated the relationship between adherence to process-based measures in HCV and three HCV-specific endpoints: receipt of antiviral treatment, completion of antiviral treatment, and clinical outcome associated with improved survival of a sustained virologic response.
The researchers studied 34,749 adults (mean age 53 years) with HCV. Of these 97 percent were men, and approximately half of the subjects were white, and 26 percent black. Data were taken from the VA registry on HCV clinical care and included patient demographics, lab tests, pharmacy information, and inpatient and outpatient care across the country. The researchers assessed seven process-of-care measures: confirmation of HCV viremia, evaluation by HCV specialists, HCV genotype testing, liver biopsy for those with genotype 1 HCV, and ruling out liver diseases related to hepatitis B, autoimmune disease, or iron overload. Also, they assessed seven process-of-care measures related to prevention and management of co-morbid conditions: HIV testing; hepatitis A and B blood tests; hepatitis A and V vaccinations; treatment of depression; and substance abuse disorder treatment.
Results show that only 11 percent of subjects received all of the appropriate initial care measures, and 8 percent received all of the appropriate care related to prevention and management of co-morbid conditions. Only 37 percent of subjects who received antiviral therapy received all the necessary monitoring of treatment effects. Patients who received optimal care before the HCV diagnosis had 3.2 times the odds of receiving antiviral therapy than patients who did not receive optimal care before diagnosis. Those who received optimal care had rates of antiviral therapy 36 percent higher than those who received suboptimal preventive and co-morbid-condition care. Researchers found that patients who received optimum process-related quality care were more likely to undergo antiviral therapy, more likely to complete treatment, and to achieve a sustained virologic response if treatment was completed. Hence it appears that higher quality of care (as measured by processes) may lead to better patient outcomes. The article titled, “Process of Care for Hepatitis C Infection Is Linked to Treatment Outcome and Virologic Response,” was published in the journal Clinical Gastroenterology and Hepatology (2012;10(11):1270–1277).