title: The Patient-Provider Relationship Is Associated with Hepatitis C Treatment Eligibility: A Prospective Mixed-Methods Cohort Study.
abstract: Hepatitis C virus (HCV) treatment has the potential to cure the leading cause of cirrhosis and hepatocellular carcinoma. However, only those deemed eligible for treatment have the possibility of this cure. Therefore, understanding the determinants of HCV treatment eligibility is critical. Given that effective communication with and trust in healthcare providers significantly influences treatment eligibility decisions in other diseases, we aimed to understand patient-provider interactions in the HCV treatment eligibility process. This prospective cohort study was conducted in the VA Pittsburgh Healthcare System. Patients were recruited after referral for gastroenterology consultation for HCV treatment with interferon and ribavirin. Consented patients completed semi-structured interviews and validated measures of depression, substance and alcohol use, and HCV knowledge. Two coders analyzed the semi-structured interviews. Factors associated with patient eligibility for interferon-based therapy were assessed using multivariate logistic regression. Of 339 subjects included in this analysis, only 56 (16.5%) were deemed eligible for HCV therapy by gastroenterology (GI) providers. In the multivariate logistic regression, patients who were older (OR = 0.96, 95%CI = 0.92-0.99, p = .049), reported concerns about the GI provider (OR = 0.40, 95%CI = 0.10-0.87, p = 0.02) and had depression symptoms (OR = 0.32, 95%CI = 0.17-0.63, p = 0.001) were less likely to be eligible. Patients described barriers that included feeling stigmatized and poor provider interpersonal or communication skills. In conclusion, we found that patients' perceptions of the relationship with their GI providers were associated with treatment eligibility. Establishing trust and effective communication channels between patients and providers may lower barriers to potential HCV cure.
authors.affiliation: Center for Health Equity Research and Promotion, Veteran's Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America.|Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Shari S
authors.initials: SS
authors.lastname: Rogal
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.affiliation: Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veteran's Administration Healthcare Service, Seattle, Washington, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Chapko
authors.affiliation: Center for Health Equity Research and Promotion, Veteran's Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Hanusa
authors.affiliation: Center for Health Equity Research and Promotion, Veteran's Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America.|Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Ada
authors.initials: A
authors.lastname: Youk
authors.affiliation: Center for Health Equity Research and Promotion, Veteran's Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York, United States of America.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevick
authors.affiliation: Center for Health Equity Research and Promotion, Veteran's Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Nichole K
authors.initials: NK
authors.lastname: Bayliss
authors.affiliation: School of Medicine, Oregon Health Sciences University, Portland, Oregon, United States of America.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Zook
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Alexis
authors.initials: A
authors.lastname: Chidi
authors.affiliation: Center for Health Equity Research and Promotion, Veteran's Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: David S
authors.initials: DS
authors.lastname: Obrosky
authors.affiliation: Center for Health Equity Research and Promotion, Veteran's Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America.|Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Zickmund
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D004608:Eligibility Determination; D005260:Female; D006282:Health Personnel; D006526:Hepatitis C / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients; D011369:Professional-Patient Relations; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires