title: Management of patients with hepatitis C in a community population: diagnosis, discussions, and decisions to treat.
abstract: BACKGROUND
  Chronic hepatitis C, a treatable condition caused by the hepatitis C virus (HCV), can be found in almost all primary care and community practices. The rate of hepatitis C treatment is low, however. This study explores the frequency of hepatitis C treatment, documented discussions of treatment consideration, and the reasons treatment may not be offered in a community population.
  
  
  METHODS
  This study is a retrospective medical record review of care provided to all patients in Olmsted County, Minn, who had a confirmed diagnosis of hepatitis C. Using all records from all health care providers in Olmsted County, the rates of documented discussions regarding hepatitis C treatment and the treatment rates by specialty of diagnosing physician were assessed. In addition, comorbidities listed as reasons not to treat and or comorbid conditions in patients without a documented treatment discussion were assessed.
  
  
  RESULTS
  Of the 366 patients with hepatitis C, 62% were men. Hepatitis C was more commonly diagnosed by generalist physicians (41% of cases). Treatment discussions were documented for 77% of patients with hepatitis C diagnosed by either a generalist or a gastrointestinal specialist (gastroenterologist or hepatologist) compared with 46% of patients with hepatitis C diagnosed by other physicians. Generalists' patients were more likely to have documented contraindications to treatment and were only one half as likely to receive hepatitis C treatment compared with patients with hepatitis C diagnosed by gastrointestinal specialists (16% vs 33%). Documented attempts to treat or reassess after resolution of potentially reversible contraindications to hepatitis C therapy were infrequent.
  
  
  CONCLUSIONS
  In this community population, hepatitis C treatment was discussed with the majority of patients with a diagnosis of hepatitis C; however, the actual treatment rate was low. Many opportunities exist for treating more patients for HCV infection, particularly those found during emergency care and chemical dependency treatment. In addition, generalists' recognition and treatment of potentially reversible contraindications to hepatitis C therapy could greatly increase the number of treatment candidates.
authors.affiliation: Department of Clinical Research, Olmsted Medical Center, Rochester, Minn 55904, USA.
authors.forename: Liliana Gazzuola
authors.initials: LG
authors.lastname: Rocca
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Yawn
authors.forename: Peter
authors.initials: P
authors.lastname: Wollan
authors.forename: W Ray
authors.initials: WR
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D015897:Comorbidity; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011320:Primary Health Care; D012189:Retrospective Studies