Multidisciplinary managed care networks-Life-saving interventions for hepatitis C patients.

Autor: Tait JM; Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK., Wang H; University of Dundee, Dundee, UK., Stephens BP; Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK., Miller M; Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK., McIntyre PG; Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK., Cleary S; University of Dundee, Dundee, UK., Dillon JF; Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK.
Jazyk: angličtina
Zdroj: Journal of viral hepatitis [J Viral Hepat] 2017 Mar; Vol. 24 (3), pp. 207-215. Date of Electronic Publication: 2016 Nov 07.
DOI: 10.1111/jvh.12633
Abstrakt: 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.
(© 2016 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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