title: Improving access to care by allowing self-referral to a hepatitis C clinic.
abstract: BACKGROUND
  Estimates suggest that more than 250,000 Canadians are infected with hepatitis C virus (HCV), but less than 10% have been treated. Access to specialists in Canada is usually via health care professional (HCP) referral and, therefore, may be a barrier to HCV care. However, clinics that operate in conjunction with the Hepatitis Support Program, Edmonton, Alberta, allow self-referral. It is hypothesized that this improves access to care without increasing inappropriate referrals.
  
  
  OBJECTIVE
  To compare the baseline characteristics and outcomes of HCV patients who self-referred with those who were HCP-referred.
  
  
  METHODS
  Data were collected from the Hepatitis Support Program HCV database and chart reviews.
  
  
  RESULTS
  Between December 17, 2002, and December 31, 2007, 1563 patients were referred including 336 self- (21.5%) and 1227 HCP-referrals (78.5%). Self- and HCP-referred patients were similar in terms of age (mean [+/- SD] 43.0+/-10.3 years versus 43.9+/-10.0 years, respectively; P=0.18), sex (56.8% versus 62.0% [men], respectively; P=0.08) and risk factors for HCV (P=0.3), with 49.7% and 52.6%, respectively, identifying injection drug use as the primary risk factor. The two groups had similar HCV genotype distributions and liver biopsy fibrosis scores with similar treatment rates (31.3% versus 33.2%; P=0.6). Treatment outcomes were excellent (sustained virological response 40.2% for genotype 1, 67% for genotypes 2 and 3) in patients completing therapy and were similar between the two groups.
  
  
  CONCLUSIONS
  Self-referred patients comprised 21.5% of patients accessing care in the clinic. Self- and HCP-referred patients had similar characteristics, treatment rates and outcomes. Facilitating self referral to an HCV clinic can improve access to care, including risk reduction education and HCV treatment.
authors: Division of Infectious Diseases, University of Alberta, Edmonton, Canada. karen.doucette@ualberta.ca
authors: K E
authors: KE
authors: Doucette
authors: V
authors: V
authors: Robson
authors: S
authors: S
authors: Shafran
authors: D
authors: D
authors: Kunimoto
mesh_terms: D000328:Adult; D000416:Alberta; D000553:Ambulatory Care; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents