title: Improving access to hepatitis C care for urban, underserved patients using a primary care-based hepatitis C clinic.
abstract: OBJECTIVE
  Chronic hepatitis C affects 200 million people worldwide and is a leading cause of death from liver disease. Effective treatment is available but can be difficult to access for uninsured, urban patients. National organizations have called for improving access to hepatitis C care in these groups. We present an innovative model for expanding access to hepatitis C care for urban, underserved patients (The Grady Liver Clinic, Grady Memorial Hospital, Atlanta, Georgia). The liver clinic provides hepatitis C care by general internists in the primary care setting.
  
  
  METHODS
  We performed a retrospective chart review of all liver clinic patients (n=807) who presented in the first 5 years of the clinic's operation. Measures included patients' demographic and hepatitis C-related characteristics; prevalence of medical, psychiatric, and substance abuse comorbidities; and treatment status.
  
  
  RESULTS
  The liver clinic population is primarily black (76%) and uninsured (59%). Patients had difficult-to-treat characteristics, including genotype 1 hepatitis C (90%), advanced liver fibrosis (28%), and high viral loads. Sixty-seven percent had comorbid medical conditions, and 40% had psychiatric disease. Fourteen percent of patients were treated for hepatitis C during the study period.
  
  
  CONCLUSIONS
  The liver clinic has proven to be a successful model for improving access to hepatitis C care for urban, underserved patients. Despite having significant hepatic disease and medical and psychiatric comorbidities, patients in the liver clinic can be successfully maintained in care and initiated on hepatitis C treatment by general internists in a primary care setting.
authors.affiliation: Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia 0303, USA. lesley.miller@emory.edu
authors.forename: Lesley
authors.initials: L
authors.lastname: Miller
authors.forename: Shelly-Ann
authors.initials: SA
authors.lastname: Fluker
authors.forename: Melissa
authors.initials: M
authors.lastname: Osborn
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Liu
authors.forename: Akilah
authors.initials: A
authors.lastname: Strawder
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005838:Genotype; D005845:Georgia; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D014505:Urban Population; D019562:Viral Load