Chronic hepatitis C infection in a rural Medicaid HMO.
BACKGROUND
Chronic hepatitis C infection (CHCI) is an increasingly common problem, affecting about 2% of the US population. The cost and complexity of treatment and difficulties in communicating with the infected population are of concern to insurers and health planners.


OBJECTIVE
To describe the clinical features of patients with CHCI in a rural Medicaid-covered population and to describe a method developed for treating CHCI in an underserved rural community.


METHODS
We developed a disease management approach to patients with CHCI receiving insurance coverage through a Medicaid HMO in rural Oregon. A locally based multidisciplinary hepatitis committee was formed to develop a management protocol and a process for selecting patients for treatment. The committee met monthly to develop the treatment plan for individual patients. Day-to-day treatment was provided by a nurse under the supervision of the committee.


RESULTS
One hundred forty-three adults with CHCI were identified by their primary care physicians. About half the patients had a type 1 genotype. Treatment with pegylated interferon and ribavirin was completed on 21 persons, 11 (52%) of whom had a virologic cure. Problems with treatment toxicity were common. Patient satisfaction with the treatment by the nurse was high.


CONCLUSIONS
CHCI is common in this rural, nonminority Medicaid-insured population. A locally based disease management model was developed that was well received by patients and was successful in delivering a high quality of care for people with CHCI in a rural area.
Calvert
James F
JF
Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA. jimcalvert@earthlink.net
Goldenberg
Paula C
PC
Schock
Cathy
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D010347:Patient Care Planning / Q000458:organization & administration*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data
D000998:Antiviral Agents