Guideline-concordant hepatitis C virus testing and notification among patients with and without mental disorders.
OBJECTIVE
We compared screening for hepatitis C virus (HCV), positive HCV test rates and test result notification among Veterans Affairs (VA) patients diagnosed with psychosis (e.g., schizophrenia, bipolar disorder) or depression or those with no psychiatric diagnosis.


METHODS
We identified all patients in the VA's External Peer Review Program national random sample of chart reviews regarding HCV care in fiscal year 2004. We then identified individuals diagnosed with psychosis or depression using data from the VA's National Psychosis and Depression registries. Using multivariable logistic regression and generalized estimating equation analyses, we evaluated associations between mental disorder diagnosis and receipt of HCV screening and notification of results.


RESULTS
Out of 19,397 patients, 94% received HCV tests. Of those tested, 6.9% were HCV positive, and of those who were positive, 48.2% were notified of their result within 60 days. After adjusting for demographic and clinical factors (including illicit drug use and comorbidities), individuals with psychosis or depression were no less likely to have a positive test or be notified of their result < or =60 days compared to nonpsychiatric groups. Those with drug use disorder diagnoses (OR=4.64; P<.001) and Blacks (OR=1.96; P<.001) were more likely to have a positive test.


CONCLUSIONS
Study limitations included inability to fully control for sociodemographic confounders (e.g., homelessness, incarceration). Nevertheless, we found that although the vast majority of patients were tested, only half were notified of test results. VA HCV prevention and follow-up strategies focus on enhanced notification overall and tailoring HCV risk reduction programs to minorities and those with drug use disorders.
Kilbourne
Amy M
AM
VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA. amykilbo@umich.edu
McCarthy
John F
JF
Himelhoch
Seth
S
Welsh
Deborah
D
Hauser
Peter
P
Blow
Frederic C
FC
D000328:Adult; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology*; D018563:Disease Notification / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D018024:Peer Review, Health Care; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D014342:Truth Disclosure; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*