title: Barriers to the treatment of hepatitis C. Patient, provider, and system factors.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is both prevalent and undertreated.
  
  
  OBJECTIVE
  To identify barriers to HCV treatment in primary care practice.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A cohort of 208 HCV-infected patients under the care of a primary care physician (PCP) between December 2001 and April 2004 at a single academically affiliated community health center.
  
  
  METHODS
  Data were collected from the electronic medical record (EMR), the hospital clinical data repository, and interviews with PCPs.
  
  
  RESULTS
  Our cohort consisted of 208 viremic patients with HCV infection. The mean age was 47.6 (+/-9.7) years, 56% were male, and 79% were white. Fifty-seven patients (27.4% of the cohort) had undergone HCV treatment. Independent predictors of not being treated included: unmarried status (adjusted odds ratio [aOR] for treatment 0.36, P=.02), female gender (aOR 0.31, P=.01), current alcohol abuse (aOR 0.08, P=.0008), and a higher ratio of no-shows to total visits (aOR 0.005 per change of 1.0 in the ratio of no-shows to total visits, P=.002). The major PCP-identified reasons not to treat included: substance abuse (22.5%), patient preference (16%), psychiatric comorbidity (15%), and a delay in specialist input (12%). For 13% of the untreated patients, no reason was identified.
  
  
  CONCLUSIONS
  HCV treatment was infrequent in our cohort of outpatients. Barriers to treatment included patient factors (patient preference, alcohol use, missed appointments), provider factors (reluctance to treat past substance abusers), and system factors (referral-associated delays). Multimodal interventions may be required to increase HCV treatment rates.
authors.affiliation: General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. jmorrill@partners.org
authors.forename: James A
authors.initials: JA
authors.lastname: Morrill
authors.forename: Melissa
authors.initials: M
authors.lastname: Shrestha
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003151:Community Health Centers / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data