scholarly journals Routine Screening and Linkage to Care for Hepatitis C Virus in an Urban Safety-Net Health System, 2017-2019

2020 ◽  
pp. 003335492096917
Author(s):  
Bijou R. Hunt ◽  
Christopher Ahmed ◽  
Kimberly Ramirez-Mercado ◽  
Christopher Patron ◽  
Nancy R. Glick
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Health System ◽  
Patient Navigation ◽  
Linkage To Care ◽  
Safety Net ◽  
Test Results ◽  
Number Of Patients ◽  
Urban Safety ◽  
Hcv Screening

Objective Hepatitis C virus (HCV) is a major threat to public health in the United States. We describe and evaluate an HCV screening and linkage-to-care program, including emergency department, inpatient, and outpatient settings, in an urban safety-net health system in Chicago. Methods Sinai Health System implemented a universal HCV screening program in September 2016 that offered patient navigation services (ie, linkage to care) to patients with a positive result for HCV on an RNA test. We collected data from February 1, 2017, through January 31, 2019, on patient demographic characteristics, risk factors, and various outcomes (eg, number of patients screened, test results, proportions of new diagnoses, number of patients eligible for patient navigation services, and proportion of patients who attended their first medical appointment). We also examined outcomes by patients’ knowledge of infection. Results Of 21 018 people screened for HCV, 6% (1318/21 018) had positive test results for HCV antibody, 68% (878/1293) of whom had positive HCV RNA test results. Of these 878 patients, 68% were born during 1945-1965, 68% were male, 65% were Black, 19% were Latino, 55% were newly diagnosed, and 64% were eligible for patient navigation services. Risk factors included past or current drug use (53%), unemployment (30%), and ever incarcerated (21%). Of 562 patients eligible for navigation services, 281 (50%) were navigated to imaging services, and 203 (72%) patients who completed imaging attended their first medical appointment. Conclusion Patient navigation played a critical role in linkage success, but securing stable, long-term financial support for patient navigators is a challenge.

scholarly journals Relationship Between Hepatitis C Clinical Testing Site and Linkage to Care

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Sabrina A. Assoumou ◽  
Wei Huang ◽  
C. Robert Horsburgh ◽  
Mari-Lynn Drainoni ◽  
Benjamin P. Linas
Keyword(s):  
Hepatitis C ◽  
Private Insurance ◽  
Linkage To Care ◽  
Safety Net ◽  
Hcv Rna ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Control And Prevention ◽  
Multivariable Regression ◽  
Testing Site

Abstract Background.  The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing of the population born between 1945 and 1965 with follow-up RNA testing for those with reactive serology. To increase the rate of diagnosis, testing may be considered in settings other than outpatient clinics (OC), such as inpatient wards (IP) or emergency department (ED). Methods.  We used electronic medical records to create a retrospective cohort with reactive HCV serology between 2005 and 2010 at an urban safety net hospital. We determined factors associated with linkage to HCV care as measured by HCV RNA testing, and we evaluated the rate of linkage to care according to diagnosis location (OC, IP, or ED). Results.  Individuals, 37 828, were tested and 5885 (16%) were reactive. Seropositivity was similar across all sites. Of the 4466 patients who met inclusion criteria, 3400 (76%) were diagnosed in the OC, whereas 967 (22%) and 99 (2%) were tested in the IP and the ED, respectively. A total of 2135 (48%) underwent HCV RNA testing. Using multivariable regression modeling, the following factors were independently associated with HCV RNA testing: diagnosis in the OC (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.42–1.90); age at diagnosis in decades (OR, 0.98; 95% CI, 0.98–0.99); private insurance (OR, 1.17; 95% CI, 1.01–1.34); and ≥10 visits after diagnosis (OR, 2.15; 95% CI, 1.89–2.44). Conclusion.  There is an opportunity to increase HCV diagnosis by testing in sites other than the OC, but this opportunity needs to be coupled with robust initiatives to improve linkage to care.

scholarly journals 920. Automated Hepatitis C Screening and Linkage to Care among Hospitalized Patients Born Between 1945-1965

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S551-S551
Author(s):  
Julia A Gasior ◽  
Rebecca Russell ◽  
Vincent Lo Re ◽  
Anne Norris ◽  
Schenevelyn Bennett ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Hospital Admission ◽  
Health System ◽  
Hospital Admissions ◽  
Linkage To Care ◽  
The United States ◽  
Quality Improvement Initiative ◽  
Hcv Rna ◽  
Hcv Antibody ◽  
Hcv Screening

Abstract Background Hepatitis C virus (HCV) infects 4.1 million people in the United States, of whom 50% are unaware of their status. In 2016, Pennsylvania introduced a law mandating HCV screening for patients born between 1945-1965 in inpatient settings. However, HCV screening during hospital admissions has remained low in part due to limited knowledge on HCV testing requirements, interpretation of results, and treatment approaches. To overcome these barriers, we implemented a quality improvement initiative to automate HCV screening as part of hospital admission order sets, facilitate linkage to HCV treatment, and sought to evaluate its effectiveness. Methods Between September 2020 and May 2021, the automated inpatient HCV screening strategy was implemented at a single 328-bed academic hospital in Philadelphia, PA. Patients born between 1945-1965 without documentation of HCV screening or diagnosis in the electronic medical record had a HCV antibody with reflexive confirmatory RNA assay automatically populated in the admission order set. Admitting providers could opt out of the screening as appropriate. All patients with reactive HCV antibody were approached by the Hepatitis Linkage Team for result disclosure, counseling, and linkage to treatment for those with HCV viremia. Cascade of care was detailed for those linked to providers within the health system. Results During the initial 8 months of the program, 2,203 patients were screened for HCV, identifying 156 with reactive HCV antibody (7.1% seroprevalence). Among 147 with completed HCV RNA assay, 51 were viremic (34.7%). Fourteen viremic patients were not linked to care, including six with a terminal illness, two who declined linkage, and six who did not respond to linkage attempts. Nine were linked to care at other health systems. Among the 28 patients linked to providers in the health system, 50% completed initial visits, 42.8% were prescribed direct acting antivirals (DAA), and 21.4% completed therapy by May 2021. One person achieved sustained virologic response 12 weeks after treatment as of May 2021 (Figure 1). Figure 1. Cascade of HCV Care Among Patients Screened During Hospital Admission from September 2020 to May 2021 Conclusion Automated inpatient HCV screening is a viable strategy to identify people with HCV and facilitate linkage to care. Optimal strategies to ensure patients access and maintain care require further study. Disclosures All Authors: No reported disclosures

Outcomes of a Pharmacist-Led Hepatitis C Virus Treatment Program in an Urban Safety-Net Health System, Chicago, 2017-2019

2021 ◽  
pp. 003335492110156
Author(s):  
Bijou R. Hunt ◽  
Hollyn Cetrone ◽  
Sharon Sam ◽  
Nancy R. Glick
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Health System ◽  
Treatment Program ◽  
Safety Net ◽  
The United States ◽  
Hcv Treatment ◽  
Treatment Cascade ◽  
Urban Safety

Objective A recommendation in March 2020 to expand hepatitis C virus (HCV) screening to all adults in the United States will likely increase the need for HCV treatment programs and guidance on how to provide this service for diverse populations. We evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago, Illinois. Methods We collected data on all patient treatment applications submitted from January 1, 2017, through June 30, 2019, and assessed outcomes of and patient retention in the treatment cascade. Results During the study period, 203 HCV treatment applications were submitted for 187 patients (>1 application could be submitted per patient): 49% (n = 91) were aged 55-64, 62% (n = 116) were male, 67% (n = 125) were Black, and 15% (n = 28) were Hispanic. Of the 203 HCV treatment applications, 87% (n = 176) of patients were approved for treatment, 91% (n = 161) of whom completed treatment. Of the 161 patients who completed treatment, 81% (n = 131) attended their sustained virologic response (SVR) follow-up visit, 98% (n = 129) of whom reached SVR. The largest drop in the treatment cascade was the 19% decline from receipt of treatment to SVR follow-up visit. Conclusion The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR. Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.

scholarly journals 296. The Hepatitis C Cascade of Care across Four Safety Net Settings in the Southeast

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S160-S161
Author(s):  
Asher J Schranz ◽  
Michael Kovasala ◽  
Candice Givens ◽  
Alison Hilton ◽  
Courtney Maierhofer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Hepatitis C ◽  
Sustained Viral Response ◽  
Community Outreach ◽  
Linkage To Care ◽  
Health Department ◽  
Safety Net ◽  
Population Based ◽  
Lower Odds

Abstract Background Despite advances in antivirals, disparities in hepatitis C (HCV) treatment remain. We evaluated persons diagnosed with HCV in 4 safety net sites in a large Southeastern county, using care cascades to conceptualize milestones in treatment. Methods Persons diagnosed with HCV in 4 screening sites across Durham County, North Carolina, from December 2015 to May 2018 were included, allowing for 9 months of follow-up. Sites included the county health department (CHD), a federally qualified health center (FQHC) where providers trained in HCV care, jail and community outreach. Persons with HCV were eligible for a bridge counselor intervention to enhance linkage to care with an HCV-treating provider (either primary care or specialist). Outcomes were monitored by chart review. Persons linked to care in the prison (n = 36) were censored from subsequent cascade steps due to inability to obtain records. Cascades were compared by the site of diagnosis. Multivariable logistic regression was used to evaluate predictors of being prescribed antivirals. Results 505 persons were diagnosed with HCV: 216 in the FQHC, 158 in the jail, 72 in the CHD, and 59 in community outreach. Overall, 89% were counseled on their diagnosis, 65% were linked to care, 41% prescribed antivirals, 38% started medications, 34% completed medications and 24% achieved sustained viral response at 12 weeks (SVR-12). Progression through the cascade was highest for those diagnosed at the FQHC (figure). In analyses adjusted for demographics and risk factors, diagnosis in a community outreach setting had lower odds of antiviral prescription, compared with diagnosis in the FQHC (OR 0.33, 95% CI 0.12–0.89). Linkage to care at a specialist clinic (vs. primary care) was associated with antiviral prescription (OR 3.82, CI 1.95–7.46). Sex, race/ethnicity, insurance status and HCV risk factors were not associated with antiviral prescription. Conclusion Among persons diagnosed with HCV across four safety net sites, a quarter achieved SVR-12. Those diagnosed in community outreach had lower odds of antiviral prescription, and those who were linked to a specialist were more likely to receive antiviral prescription. Improving progression through cascade milestones across safety-net settings is integral to improving population-based HCV outcomes. Disclosures All authors: No reported disclosures.

scholarly journals Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system

2021 ◽  
Vol 2 ◽  
pp. 263348952110437
Author(s):  
Ana M Progovac ◽  
Miriam C Tepper ◽  
H. Stephen Leff ◽  
Dharma E Cortés ◽  
Alexander (Cohen) Colts ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Behavioral Health ◽  
Program Implementation ◽  
Health Management ◽  
Safety Net ◽  
Clinical Settings ◽  
Urban Safety ◽  
Core Components ◽  
Health Home

Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees’ transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6–7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6–7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.

scholarly journals Hepatitis C Virus Infection and Increasing Screening and Linkage to Care in a Large Integrated Health System

2016 ◽  
Vol 3 (3) ◽  
pp. 177 ◽  
Author(s):  
Carla V Rodriguez ◽  
Kevin B Rubenstein ◽  
Haihong Hu ◽  
Benjamin P Linas ◽  
Michael Horberg
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Virus Infection ◽  
Health System ◽  
Linkage To Care ◽  
Hepatitis C Virus Infection ◽  
Integrated Health
Sign in / Sign up

Export Citation Format

Share Document