title: Multidisciplinary managed care networks-Life-saving interventions for hepatitis C patients.
abstract: Successful hepatitis C virus (HCV) therapy depends on effective pathways of care. Over two decades, we have developed four sequential models of care latterly using a multidisciplinary managed care network to improve HCV testing, care and treatment. This was a cohort study to evaluate the effectiveness of care pathways, carried out using all HCV antibody-positive individuals tested in a geographical region between 1994 and 2014. The study involved 3122 HCV-positive patients. They were divided into four subgroups representing different care pathways defined by their date of HCV antibody diagnosis. The number who accessed treatment services within 1 year of diagnosis increased from 77 of 292 (26.3%) to 521 of 821 (72.9%). The rate of treatment starts within 1 year of diagnosis increased from 6 of 292 (2.0%) to 133 of 821 (16.2%), and the sustained viral response rate improved from 61.6% to 77.4%. All-cause mortality decreased from 232 of 688 (33.7%) in subgroup A to 55 of 1207 (4.5%) in subgroup D, and multivariate analysis showed that pathway type was an independent predictor of mortality irrespective of age, sex, SVR status or HIV co-infection with pathway in D having an odds ratio of 0.53(0.40-0.77; P<.001) compared to pathway in A. At study end, 78% (3122) of an estimated 4000 HCV positive had been diagnosed. In total, 97.5% of HCV caseload was referred to specialist services and 89% attended for assessment. The introduction of a managed care network increased access to care and reduced all-cause mortality.
authors.affiliation: Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Tait
authors.affiliation: University of Dundee, Dundee, UK.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: B P
authors.initials: BP
authors.lastname: Stephens
authors.affiliation: Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.affiliation: Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: McIntyre
authors.affiliation: University of Dundee, Dundee, UK.
authors.forename: S
authors.initials: S
authors.lastname: Cleary
authors.affiliation: Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Dillon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006302:Health Services Research; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D009026:Mortality; D016019:Survival Analysis; D000072230:Sustained Virologic Response; D016896:Treatment Outcome; D006113:United Kingdom
keywords: access to care; hepatitis C virus; managed care networks; people who inject drugs; sustained viral response