title: The impact of a managed care network on attendance, follow-up and treatment at a hepatitis C specialist centre.
abstract: Infection with the hepatitis C virus commonly occurs in patient groups who have difficulty accessing conventional medical care, reducing their chance of successful antiviral therapy. Managed care networks (MCNs) have been suggested as a mechanism of improving access to care; however, there is little evidence to support their use in patients with hepatitis C. The aim of this study was to evaluate the impact of a MCN for patients with hepatitis C. This was a retrospective cohort study of all individuals in our area who had received a positive hepatitis C antibody test between August 1994 and June 2008. The MCN introduced a new referral pathway, which included nonmedical referrals and outreach nurse-led clinics. These interventions were introduced in 2004 and evaluated in 2008. After the introduction of the MCN, the proportion of individuals who accessed care increased from 61% (280/430) to 82.4% (721/875). There was an increase in nonmedical referrals with 81 (18.3%) being directly referred from Drug Problem Services and 75 (17%) from the Prison Service. The changes to referral did not have a negative impact on treatment outcomes as the number who completed treatment increased from 66.1% (43/65) to 73.7% (98/133) and the sustained virological response increased from 50.7% (33/65) to 60.9% (81/133). This study provides evidence that the collaboration of health care professionals within a network can have a radical effect in improving access to care in a traditionally hard to reach population. This has been achieved with little additional resource, but rather working smarter with existing staff.
authors.affiliation: Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK. jantait@nhs.net
authors.forename: J M
authors.initials: JM
authors.lastname: Tait
authors.forename: P G
authors.initials: PG
authors.lastname: McIntyre
authors.forename: S
authors.initials: S
authors.lastname: McLeod
authors.forename: D
authors.initials: D
authors.lastname: Nathwani
authors.forename: J F
authors.initials: JF
authors.lastname: Dillon
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006302:Health Services Research; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult