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IMPROVING ACCESS TO CARE BY ALLOWING SELF REFERRAL TO A HEPATITIS C CLINIC
K Doucette1, V Robson2, D Kunimoto1
1Division of Infectious Diseases; 2Hepatitis Support Program, University of Alberta, Edmonton, AB
INTRODUCTION: An estimated 250 000 (0.8%) Canadians are chronically infected with hepatitis C virus (HCV), however less than 10% have been treated. In the Canadian system, access to specialists is almost exclusively by physician (MD) referral and therefore may be a barrier to HCV care for some patients. As such, our HCV clinic allows patients to self refer for assessment.
Objectives and METHODS: The goals of this study were to determine the proportion of patients who self referred as well as to compare the baseline characteristics and outcomes of self referred patients to those referred by MDs. Data was collected through database and chart review.
RESULTS: Between January, 2003 and December, 2006, 1207 patients were referred with 236 (19.6%) self and 971 (80.4%) MD referrals. Although not routinely asked, reported reasons for self referral included no MD, told by MD no treatment available and told by MD HCV was “dormant”. Self and MD referred patients were similar in terms of age (mean 42.2 ± 10.0 vs. 43.5 ± 9.9 years; p=0.07), gender (55.5% vs. 61.5% male; p=0.09) and risk factors for HCV (p=0.3) with 49.6% and 54.9% respectively identifying injection drug use as the primary risk. A similar proportion of patients completed the initial evaluation with a nurse and MD in the clinic (54.7% vs. 61.2%; p=0.06), however those who self referred were less likely to complete baseline laboratory investigations (not complete in 23.3% vs. 13.4%; p=0.002). The 2 groups had similar distributions of HCV genotypes and liver biopsy fibrosis scores. Despite this, patients who self referred were less likely to be treated (15.2% vs. 23.2%; p=0.008). In those treated however, SVR was similar in the 2 groups (38.9% vs. 35.6%; p=0.9).
Discussion and CONCLUSIONS: These data demonstrate that in a HCV clinic model allowing self referral, almost 20% of patients access care through this mechanism. Although patients who self referred were less likely to complete baseline laboratory investigations or undergo HCV therapy, they were equally likely to complete the nursing and MD assessment where education regarding HCV natural history and risk reduction were provided. Those who were treated had SVR rates similar to the MD referred group. In conclusion, facilitating self referral to an HCV clinic can improve access to risk reduction education and HCV treatment.