Specialists Boost HCV Treatment Rates in Veterans

By Dave Levitan

NEW YORK (Reuters Health) Nov 23 - HCV treatment rates are low among veterans, but consultation with a specialist can drastically increase the likelihood of therapy.

"The study supports previous findings of low treatment rates reported in single or few centers in the VA, and extends the findings to the entire national VA system," said the new study's lead author Dr. Jennifer Kramer, of the Michael E. DeBakey Veterans Affairs Medical Center in Houston, in an e-mail to Reuters Health.

Dr. Kramer and colleagues used retrospective data from the Veterans Affairs hepatitis C virus Clinical Case Registry to evaluate 29,695 patients diagnosed with the virus between 2003 and 2004. Overall, only 4,213 patients (14.2%) received treatment. The study's results were published online ahead of print November 9th in the American Journal of Gastroenterology.

Several patient, provider and facility-related factors influenced whether or not a patient received treatment. Black patients had an adjusted odds ratio for receiving treatment of 0.52 compared with white patients (p<0.0001). Patients older than 65 also had a significantly lower chance of being treated (OR, 0.32; p<0.0001) compared to those under 45 years, as did male patients (OR, 0.53; p<0.0001).

Patients with cirrhosis were significantly more likely to receive treatment (OR, 2.11; p<0.0001), and those with alcohol or other drug abuse, anxiety, post-traumatic shock disorder or severe depression were less likely.

"According to our findings, seeing a specialist consultant was the most important predictor for receipt of hepatitis C virus treatment," Dr. Kramer said, with an OR of 9.34.

"Clinical reminders for timely referral and the availability of adequate capacity of trained specialists are some of the basic needs for managing this disease."

Dr. Kramer said that the generally low treatment rates in the VA system could be improved by interventions targeting factors that are considered as barriers to treatment; these include depression and alcohol abuse. Her group is in the early stages of a new study of a "collaborative depression management" program in four VA hospitals that Dr. Kramer hopes will help remove one of the modifiable barriers to hepatitis C treatment.

Am J Gastroenterol. Posted online November 9, 2010. Abstract

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