Multidisciplinary managed care networks—Life‐saving interventions for hepatitis C patients

• Published in: Journal of viral hepatitis Vol. 24; no. 3; pp. 207 - 215
• Main Authors: Tait, J. M., Wang, H., Stephens, B. P., Miller, M., McIntyre, P. G., Cleary, S., Dillon, J. F.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2017
• Subjects: access to care; Adult; Cohort Studies; Female; Health care networks; Health risk assessment; Health Services Research; Hepatitis; hepatitis C virus; Hepatitis C, Chronic - diagnosis; Hepatitis C, Chronic - drug therapy; Humans; Male; managed care networks; Managed Care Programs - organization & administration; Mortality; Multivariate analysis; people who inject drugs; Survival Analysis; sustained viral response; Sustained Virologic Response; Treatment Outcome; United Kingdom; hepatitis C virus; sustained viral response; access to care; managed care networks; people who inject drugs
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/jvh.12633

Summary
Successful hepatitis C virus (HCV) therapy depends on effective pathways of care. Over two decades, we have developed four sequential models of care latterly using a multidisciplinary managed care network to improve HCV testing, care and treatment. This was a cohort study to evaluate the effectiveness of care pathways, carried out using all HCV antibody‐positive individuals tested in a geographical region between 1994 and 2014. The study involved 3122 HCV‐positive patients. They were divided into four subgroups representing different care pathways defined by their date of HCV antibody diagnosis. The number who accessed treatment services within 1 year of diagnosis increased from 77 of 292 (26.3%) to 521 of 821 (72.9%). The rate of treatment starts within 1 year of diagnosis increased from 6 of 292 (2.0%) to 133 of 821 (16.2%), and the sustained viral response rate improved from 61.6% to 77.4%. All‐cause mortality decreased from 232 of 688 (33.7%) in subgroup A to 55 of 1207 (4.5%) in subgroup D, and multivariate analysis showed that pathway type was an independent predictor of mortality irrespective of age, sex, SVR status or HIV co‐infection with pathway in D having an odds ratio of 0.53(0.40‐0.77; P<.001) compared to pathway in A. At study end, 78% (3122) of an estimated 4000 HCV positive had been diagnosed. In total, 97.5% of HCV caseload was referred to specialist services and 89% attended for assessment. The introduction of a managed care network increased access to care and reduced all‐cause mortality.