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BACKGROUND/RATIONALE:
Hepatitis C has been seen as an epidemic which threatens to overrun the VA healthcare system if successful treatment strategies are not found. Between 4-17% of veterans are infected with the hepatitis C virus (HCV), compared to 2% in the non-veteran population. Current studies show that HCV infection can be cured with therapy in up to 60% of patients. However, only 8% of all HCV infected veterans in the VA Healthcare System enter antiviral therapy. It is important to increase enrollment into therapy as HCV results in cirrhosis in 20% and death in 10% of cases, and has already become the leading cause for liver transplantation. Although the VA has been successful in increasing referrals to the Gastroenterology (GI) service for HCV infected patients, a study of GI consults found that 57% of patients never attend the first appointment. Our own results find that of those who do attend their initial consult and for whom the provider has recommended that they proceed with treatment, 65% choose not to begin antiviral therapy. The reasons for the low enrollment by veterans into treatment are poorly understood. Studies have found a limited knowledge of HCV infection by patients and physicians. Our own results show that patients report problems or even frank stigmatization when interacting with their healthcare providers, leading to feelings of abandonment and dissatisfaction with care. However, these studies were cross-sectional in design and did not involve veterans, who have significantly higher prevalence and lower treatment rates.
OBJECTIVE(S):
To discover the factors associated with initiating antiviral therapy, we propose the Patient/provider Attitude Toward Hepatitis Study (PATHS). This study is designed to approach veterans referred to GI for an initial HCV treatment consultation, and to follow those who attend that appointment prospectively until they either enroll in treatment or dropout. PATHS also proposes to examine provider knowledge of HCV, and their attitudes toward its treatment and patients. The study is designed to address the following specific objectives: 1) examine whether patient knowledge of HCV and perception of communication with the referring provider is associated with attendance at an initial GI consult appointment; 2) examine whether patient knowledge of HCV and perception of communication with the consulting GI provider is associated with initiation of HCV treatment; 3) examine whether provider knowledge of HCV, and attitudes toward its treatment and patients is associated with patients' attendance at an initial GI consult appointment and their initiating HCV treatment.
METHODS:
This is a prospective study of veterans referred to the VA Pittsburgh and Puget Sound GI clinic for treatment of their HCV. Data are to be collected from patients placed on a referral list for a HCV consultation, from their referring providers, during a follow up phase from those patients who attended the initial consultation, and from the consulting GI provider. The study uses two primary methodologies: 1) the first is a series of structured surveys with items measuring patient knowledge of HCV, patient perception of communication with providers, as well as provider knowledge of HCV, and their attitudes toward its treatment and patients; 2) the second is a semi-structured interview that will be analyzed with qualitative techniques. The interview that will be used with the patients focuses on patient perceptions of barriers to antiviral therapy within the VA, knowledge and understanding of the HCV treatment, and attitudes and trust in providers related to their HCV.
FINDINGS/RESULTS:
Currently 287 of 395 (72%) eligible patients have been enrolled, with 29 refusing to participate, 47 attending their initial consultation without expressing interest in participating, and 32 being either unavailable for contact or being monitored for future recruitment. Recruitment is on-going.
IMPACT:
This study is the first investigation to provide comprehensive insights into the fact that over 75% of potentially eligible veterans do not initiate or complete evaluations needed to begin antiviral therapy for hepatitis C. The project focuses on patient perceptions of HCV treatment, while also exploring the role of provider knowledge of HCV, and their attitudes toward treatment and patients. It will provide novel and important information about different factors that contribute to the persistently low treatment rate. The results will provide critical information needed to design behavioral interventions that will address knowledge gaps and to develop communication strategies to enhance patient satisfaction and treatment adherence.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Communication and Decision Making, Treatment
Keywords:
Behavior (patient), Behavior (provider), Communication -- doctor-patient
MeSH Terms:
none
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