Factors associated with lost to follow-up after hepatitis C treatment delivered by primary care teams in an inner-city multi-site program, Vancouver, Canada

BackgroundLoss to follow-up is an under-recognised problem in primary care. Continuity with a primary care provider improves morbidity and mortality in the Veterans Health Administration. We sought to reduce the percentage of patients lost to follow-up at the Northeast Ohio Veterans Affairs Healthcare System from October 2017 to March 2019.MethodsThe Panel Retention Tool (PRT) was developed and tested with primary care teams using multiple Plan, Do, Study and Act cycles to identify and schedule lost to follow-up patients. Baseline data on loss to follow-up, defined as the percentage of panelled patients not seen in primary care in the past year, was collected over 6 months during tool development. Outcomes were tracked from implementation through spread and sustainment (12 months) across 14 primary care clinics.ResultsOf the 96 170 panelled patients at the beginning of the study period, 2715 (2.8%) were found to be inactive and removed from provider panels, improving panel reliability. Among the remaining, 1856 (1.9%) patients without scheduled follow-up were scheduled for future care, and 1239 (1.3%) without recent prior care completed encounters during the study period. The percentage of patients lost to follow-up decreased from 10.1% (lower control limit (LCL) 9.8%–upper control limit (UCL) 10.4%) at baseline to 6.4% (LCL 6.2%–UCL 6.7%) postintervention and patients without planned future care decreased from 21.7% (LCL 21.3%–UCL 22.1%) to 17.1% (LCL 16.7%–UCL 17.5%).ConclusionsThe PRT allowed primary care teams in an integrated health system to identify and schedule lost to follow-up patients. Ease of use, adaptability and encouraging outcomes facilitated spread. This has the potential to contribute to more appropriate utilisation of healthcare resources and improved access to primary care.

Download Full-text

S1124 Reasons for Lost to Follow-Up in Patients With Advanced Hepatic Fibrosis After Completion of Hepatitis C Treatment in a Midwest Urban Safety Net Hospital: A Sampling-Based Approach

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000706544.65061.dc ◽

2020 ◽

Vol 115 (1) ◽

pp. S566-S566

Author(s):

Subhan Ahmad ◽

Andrew M. Ford ◽

Imad Asaad

Keyword(s):

Hepatitis C ◽

Hepatic Fibrosis ◽

Safety Net ◽

Hepatitis C Treatment ◽

Safety Net Hospital ◽

Urban Safety ◽

Lost To Follow Up

Download Full-text

Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada

Current Oncology ◽

10.3390/curroncol28010004 ◽

2020 ◽

Vol 28 (1) ◽

pp. 13-25

Author(s):

Soleil Chahine ◽

Gordon Walsh ◽

Robin Urquhart

Keyword(s):

Primary Care ◽

Nova Scotia ◽

Cancer Survivors ◽

Sociodemographic Factors ◽

Patient Navigator ◽

Care Providers ◽

Psychosocial Needs ◽

Factors Associated ◽

Follow Up Care

Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.

Download Full-text

Factors associated with being lost to follow-up before completing tuberculosis treatment: analysis of surveillance data

Epidemiology and Infection ◽

10.1017/s095026881200163x ◽

2012 ◽

Vol 141 (6) ◽

pp. 1223-1231 ◽

Cited By ~ 6

Author(s):

E. R. C. MILLETT ◽

D. NOEL ◽

P. MANGTANI ◽

I. ABUBAKAR ◽

M. E. KRUIJSHAAR

Keyword(s):

Surveillance Data ◽

Sputum Smear ◽

Tuberculosis Patients ◽

Factors Associated ◽

Increased Risk ◽

Patients At Risk ◽

Treatment Analysis ◽

The Uk ◽

Lost To Follow Up

SUMMARYCompletion of treatment is key to tuberculosis control. Using national surveillance data we assessed factors associated with tuberculosis patients being lost to follow-up before completing treatment (‘lost’). Patients reported in England, Wales and Northern Ireland between 2001 and 2007 who were lost 12 months after beginning treatment were compared to those who completed, or were still on treatment, using univariable and multivariable logistic regression. Of 41 120 patients, men [adjusted odds ratio (aOR) 1·29; 95% confidence interval (CI) 1·23–1·35], 15- to 44-year-olds (P<0·001), and patients with pulmonary sputum smear-positive disease (aOR 1·25, 95% CI 1·12–1·45) were at higher risk of being lost. Those recently arrived in the UK were also at increased risk, particularly those of the White ethnic group (aOR 6·39, 95% CI 4·46–9·14). Finally, lost patients had a higher risk of drug resistance (aOR 1·41, 95% CI 1·17–1·69). Patients at risk of being lost require enhanced case management and novel case retention methods are needed to prevent this group contributing towards onward transmission.

Download Full-text

Budgetary impact analysis of a primary care-based hepatitis C treatment program: Effects of 340B Drug Pricing Program

PLoS ONE ◽

10.1371/journal.pone.0213745 ◽

2019 ◽

Vol 14 (3) ◽

pp. e0213745 ◽

Cited By ~ 4

Author(s):

Eric A. Jones ◽

Benjamin P. Linas ◽

Ve Truong ◽

James F. Burgess ◽

Karen E. Lasser

Keyword(s):

Primary Care ◽

Hepatitis C ◽

Treatment Program ◽

Impact Analysis ◽

Drug Pricing ◽

Hepatitis C Treatment ◽

Budgetary Impact ◽

Program Effects

Download Full-text

Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes

Emergency Medicine Journal ◽

10.1136/emermed-2019-208637 ◽

2019 ◽

Vol 37 (2) ◽

pp. 102-105 ◽

Cited By ~ 1

Author(s):

Conor Grant ◽

Sarah O'Connell ◽

Darren Lillis ◽

Anne Moriarty ◽

Ian Fitzgerald ◽

...

Keyword(s):

Hepatitis C ◽

Hepatitis B ◽

Screening Programme ◽

Linkage To Care ◽

Opt Out ◽

B Virus ◽

Lost To Follow Up ◽

The Impact ◽

Test Result

BackgroundWe initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care.MethodsFrom July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months.ResultsOver the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care.ConclusionAlthough high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.

Download Full-text

FRI-230-Rapid starts to stop hepatitis C: Same day hepatitis C treatment starts enhancing patient engagement and follow-up in a vulnerable, treatment naïve group living with hepatitis C

Journal of Hepatology ◽

10.1016/s0618-8278(19)30975-2 ◽

2019 ◽

Vol 70 (1) ◽

pp. e496

Author(s):

Shawn Greenan ◽

George Carruthers ◽

Lisa Barrett

Keyword(s):

Hepatitis C ◽

Patient Engagement ◽

Group Living ◽

Hepatitis C Treatment ◽

Naive Group ◽

Treatment Naïve

Download Full-text

Hepatitis C elimination in the Netherlands (CELINE): study protocol for nationwide retrieval of lost to follow-up patients with chronic hepatitis C

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000396 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000396 ◽

Cited By ~ 2

Author(s):

Cas J Isfordink ◽

Sylvia M Brakenhoff ◽

Marleen van Dijk ◽

Marc van der Valk ◽

Rob J de Knegt ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

The Netherlands ◽

Chronic Hepatitis C ◽

Hcv Rna ◽

Ethical Approval ◽

Hcv Transmission ◽

Chronic Hcv ◽

Lost To Follow Up

BackgroundThe Netherlands has a low hepatitis C virus (HCV) prevalence, estimated at 0.16%. Previous studies have shown that up to 30% of the diagnosed HCV population in the Netherlands has been lost to follow-up (LTFU). Retrieval of these patients could halt progression of liver disease in infected patients, reduce the number of infected individuals and limit HCV transmission. Several regional Dutch retrieval projects have already been executed, which demonstrated that retrieval is feasible. Therefore, we initiated a nationwide retrieval project, aiming to achieve microelimination in previously diagnosed but LTFU patients with chronic HCV through retrieval.MethodsLaboratory records will be used to identify possible patients with chronic hepatitis C, defined as either a positive most recent HCV RNA or positive HCV antibodies without known RNA result. Reviewing patient records and obtaining current contact information from municipality databases will identify LTFU patients who are eligible for retrieval. These patients will be invited for outpatient clinic care. The primary outcome of the study is the total number of LTFU patients who have been successfully linked to care.DiscussionHepatitis C ELimination In the NEtherlands (CELINE) is within the remit of WHO elimination targets and the Dutch National Hepatitis Plan. The methodology of CELINE is based on previously conducted regional retrieval projects and is designed to overcome some of their limitations. After ethical approval was obtained in 2018, the first centre initiated retrieval in 2018 and the project is expected to finish in 2021.Trial registration numberNCT04208035.

Download Full-text

A prospective study to evaluate the acceptance, efficacy, side effects and expulsion rates of post-placental intrauterine device

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174628 ◽

2017 ◽

Vol 6 (11) ◽

pp. 4821

Author(s):

Richa S. Sankhe ◽

Meenal T. Kamble

Keyword(s):

Side Effects ◽

Intrauterine Device ◽

Excessive Bleeding ◽

Factors Associated ◽

Insertion Techniques ◽

Insertion Efficacy ◽

Post Placental ◽

A Prospective Study ◽

Lost To Follow Up

Background: This study was conducted to know the factors associated with acceptability of immediate post placental IUCD insertion in women and to know the level of safety, efficacy and expulsion of post placental insertion of IUCD.Methods: This study was conducted in Obstetrics and Gynecology Department of Kasturba General Hospital, Mumbai over a period of 1 year. Women admitted and delivered at KGH were informed and counselled regarding intrauterine devices regarding its insertion, efficacy and side effects. Cu T 380A was inserted within 15 minutes of delivery of placenta and membranes in women who gave consent and had no contraindications for IUD insertion. All these women were followed for 6 months in the post insertion period.Results: Total number of women counselled was 400 over the period of six months from August 2015 to January 2016. Out of these only 250 women gave consent for PPIUCD insertion. 50 were lost to follow up. 200 women were followed, out of which 15 women had expulsion, 15 women had excessive bleeding, 20 women complained of pelvic pain, bleeding and abdominal pain together was found in 25 women. 160 out of 200 continued with the method while the rest discontinued.Conclusions: Based on present study it may be concluded that post placental intrauterine device is an effective method of contraception. Proper counselling and insertion techniques would further improve the acceptability and reduce the expulsion rates.

Download Full-text