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According to Dr. Fasiha Kanwal of
the Michael E. DeBakey Veterans Affairs (VA) Medical Center in Houston, Texas,
and colleagues, patients with hepatitis C virus (HCV) infections are more
likely to begin antiviral therapy and achieve a sustained virologic response if
they already have high-quality health care. The researchers evaluated the
relationship between adherence to process-based measures in HCV and three
HCV-specific endpoints: receipt of antiviral treatment, completion of antiviral
treatment, and clinical outcome associated with improved survival of a
sustained virologic response.
The researchers studied 34,749
adults (mean age 53 years) with HCV. Of these 97 percent were men, and
approximately half of the subjects were white, and 26 percent black. Data were
taken from the VA registry on HCV clinical care and included patient
demographics, lab tests, pharmacy information, and inpatient and outpatient care
across the country. The researchers assessed seven process-of-care measures:
confirmation of HCV viremia, evaluation by HCV specialists, HCV genotype
testing, liver biopsy for those with genotype 1 HCV, and ruling out liver
diseases related to hepatitis B, autoimmune disease, or iron overload. Also,
they assessed seven process-of-care measures related to prevention and
management of co-morbid conditions: HIV testing; hepatitis A and B blood tests;
hepatitis A and V vaccinations; treatment of depression; and substance abuse
disorder treatment.
Results show that only 11 percent of
subjects received all of the appropriate initial care measures, and 8 percent
received all of the appropriate care related to prevention and management of
co-morbid conditions. Only 37 percent of subjects who received antiviral
therapy received all the necessary monitoring of treatment effects. Patients
who received optimal care before the HCV diagnosis had 3.2 times the odds of
receiving antiviral therapy than patients who did not receive optimal care
before diagnosis. Those who received optimal care had rates of antiviral
therapy 36 percent higher than those who received suboptimal preventive and
co-morbid-condition care. Researchers found that patients who received optimum
process-related quality care were more likely to undergo antiviral therapy,
more likely to complete treatment, and to achieve a sustained virologic
response if treatment was completed. Hence it appears that higher quality of
care (as measured by processes) may lead to better patient outcomes. The
article titled, “Process of Care for Hepatitis C Infection Is Linked to
Treatment Outcome and Virologic Response,” was published in the journal
Clinical Gastroenterology and Hepatology (2012;10(11):1270–1277).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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