title: Identification and management of hepatitis C patients in primary care clinics.
abstract: OBJECTIVE
  Previous survey-based research suggested that hepatitis C patients receive suboptimal care in primary care settings. The aim of our study was to define the actual level of care hepatitis C patients receive in primary care clinics.
  
  
  METHODS
  Medical records of 229 hepatitis C antibody-positive (group 1), 229 hepatitis C antibody-negative (group 2), and 229 patients not tested for hepatitis C antibody (group 3) were reviewed to assess the indications for hepatitis C testing and the subsequent management and referral of hepatitis C antibody-positive patients diagnosed in primary care clinics. In addition, the compliance of primary care physicians with hepatitis C screening and testing guidelines was assessed.
  
  
  RESULTS
  Only 16% of group 1 and 10% of group 2 patients were tested for hepatitis C based on physician-identified risk factors. Only 1% of group 3 patients had documented discussion of hepatitis C risk factors during their initial visit with a primary care physician. The majority of hepatitis C antibody-positive patients was appropriately evaluated in primary care clinics, and most (77%) hepatitis C RNA-positive patients with elevated liver enzymes were referred for subspecialty care. Of the 59 patients who underwent liver biopsy, 40% had bridging fibrosis or cirrhosis.
  
  
  CONCLUSIONS
  Hepatitis C testing is rarely initiated in primary care clinics based on physician-identified risk factors. Interventions should be developed to optimize early diagnosis of hepatitis C as significant liver disease may be present despite the absence of symptoms.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Shehab
authors.forename: Mauricio
authors.initials: M
authors.lastname: Orrego
authors.forename: Renu
authors.initials: R
authors.lastname: Chunduri
authors.forename: Anna S F
authors.initials: AS
authors.lastname: Lok
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008499:Medical Records; D008824:Michigan; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012367:RNA, Viral / Q000302:isolation & purification; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral