title: Variation in hepatitis C services may lead to inequity of heath-care provision: a survey of the organisation and delivery of services in the United Kingdom.
abstract: BACKGROUND
  Chronic hepatitis C infection (CHC) is a major healthcare problem. Effective anti-viral therapy is available. To maximise population effectiveness, co-ordinated services for detection and management of patients with CHC are required. There is a need to determine patterns of healthcare delivery to plan improvements. A study was conducted to determine workload, configuration and care processes of current UK services available to manage patients with CHC.
  
  
  METHODS
  A cross-sectional questionnaire survey of consultant members of British Association for the Study of the Liver (n = 53), Infectious Disease consultants (n = 43), and a 1 in 5 sample of Genito-Urinary Medicine (n = 48) and gastroenterologists (n = 200).
  
  
  RESULTS
  Response rate was 70%. 40% of respondents provided a comprehensive service (included treatment and follow-up): speciality of clinical leads identified as Hepatology (37%); Gastroenterology (47%); and Infectious Disease (16%). The estimated number of patients managed by respondents was about 23,000 with an upward trend over the previous 3 years. There was variation between comprehensive service providers, including unit size, eligibility criteria for treatment, and drug regimes. Key barriers to quality of care identified were staffing capacity, funding of treatment and patient non-attendance. Most English strategic health authorities had at least one comprehensive service provider.
  
  
  CONCLUSIONS
  There was significant variation in all aspects of the patient pathway which may contribute to inequity of health care provision. Services need to be expanded to form geographical clinical networks, and properly resourced to ensure greater uptake and more equitable delivery of services if the future burden of chronic liver disease is to be reduced.
authors.affiliation: Public Health Sciences & Medical Statistics (805) Level C, University of Southampton, Southampton General Hospital, Tremona Road, Southampton UK. jules@soton.ac.uk
authors.forename: Julie
authors.initials: J
authors.lastname: Parkes
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.forename: Bethan
authors.initials: B
authors.lastname: Bennett-Lloyd
authors.forename: William
authors.initials: W
authors.lastname: Rosenberg
mesh_terms: D019091:Critical Pathways; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006526:Hepatitis C / Q000188:drug therapy*; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation; D013222:State Medicine; D006113:United Kingdom