The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force (USPTF) recommend screening for Hepatitis C (HCV) among patients born between 1945 and 1965. With the advent of novel highly effective therapies, we evaluated the current HCV screening rates along with linkage to care for patients with active disease.
We used the Henry Ford Health System records to create a retrospective cohort of patients born between 1945 – 1965 seen at 21 internal medicine clinics between July 2014 and June 2015. Patients previously screened for HCV and those with established disease were excluded. We studied patient socio-demographic and medical conditions along with provider-specific factors associated with likelihood of screening. Patients who tested positive were reviewed to assess appropriate linkage to care and treatment.
47,304 patients were included in our study cohort and 40,561 patients met inclusion criteria. A total of 8,657 (21.3%) were screened. Screening rates were found to be higher among men (p < 0.001) and African Americans (p <0.001). The rates were lower in patients with multiple comorbidities (p <0.001) and fewer clinic visits (p <0.001). Practice setting influenced screening rates as patients seen in residency teaching clinics were more likely to be screened (p <0.001). Patient electronic health engagement was associated with higher screening rates (p <0.001).
Among patients who were screened, 117 (1.4 %) patients tested positive. After excluding patients without active viremia, 78% of patients were referred to a Hepatitis C specialist and 50% were successfully evaluated. On follow-up, 27% of HCV positive patients received treatment with Direct Acting Anti-virals.
Medicaid patients were less likely to be treated (p <0.05) along with a trend towards a decrease in likelihood of treatment among patients with lower income. Electronic health engagement was again a significant factor that increased the odds of treatment (p <0.05).
HCV screening rates are suboptimal with a significant influence of sociodemographic and provider-specific factors. Furthermore, patients who tested positive had inadequate linkage to care with a major disadvantage for Medicaid and low income patients. This accentuates the need for a more robust and equitable care delivery system. The study also highlights a promising role for patient’s engagement in electronic health portals through active linkage at multiple phases of the care cascade.