Hepatitis C risk assessment, testing and referral for treatment in urban primary care: Role of race and ethnicity

Abstract

Racial differences exist with respect to HCV risk factor ascertainment and testing, (3) Minority patients, positive for HCV, are less likely to be referred for subspecialty care and treatment. Overall, minorities are less likely to be tested for HCV than whites in the presence of a known risk factor. INTRODUCTIONSeveral studies have suggested that hepatitis C (HBV) manage-ment is suboptimal in primary care settings [1][2][3][4][5] . In fact, only 59% of primary care physicians (PCPs) reported asking patients about HCV risk factors [3] . A similar conclusion was made by another study which found that 46% and 62% of physicians reported that they routinely asked patients about a history of blood transfusion and injection drug use, respectively [4] . Shehab reported that HCV testing is rarely initiated in primary care clinics based on physician identified risk factors such as transfusion prior to 1992 or a history of injection drug use [1] . Similar studies among urban primary care practices, comprising patients at highest risk for exposure to HCV risk factors, have not been reported. Such a study would be important to better assess the feasibility of implementing wide scale risk assessment, testing, and treatment strategies.The purpose of this retrospective cohort study is to assess the rates of HCV risk factor ascertainment, testing and referral for treatment in urban primary care practices, with particular attention to the effect of race and ethnicity as determined by systematic review of the medical records. Abstract AIM: To determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity. MATERIALS AND METHODS METHODS:Retrospective chart review from four primary care sites in Philadelphia; two academic primary care practices and two community clinics was performed. Demographics, HCV risk factors, and other risk exposure information were collected. RESULTS:Four thousand four hundred and seven charts were reviewed. Providers documented histories of injection drug use (IDU) and transfusion for less than 20% and 5% of patients, respectively. Only 55% of patients who admitted IDU were tested for HCV. Overall, minorities were more likely to have information regarding a risk factor documented than their white counterparts (79% vs 68%, P < 0.0001). Hispanics were less likely to have a risk factor history documented, compared to blacks and whites (P < 0.0001). Overall, minorities were less likely to be tested for HCV than whites in the presence of a known risk factor (23% vs 35%, P = 0.004). Among patients without documentation of risk factors, blacks and Hispanics were more likely to be tested than whites (20% and 24%, vs 13%, P < 0.005, respectively). CONCLUSION:(1) Documentation of an HCV risk factor history in urban primary care is uncommon, (2)

Evaluation of immigration status, race and language barriers on chronic hepatitis C virus infection management and treatment outcomes

“…Immigration status, race and language barriers have been identified as factors that impede access to HCV-related health care in many developed countries [10,11]. Given the heavy burden of HCV infection in immigrants living in Canada and other developed regions of the world, these factors need to be considered to ensure that immigrant populations receive adequate care [15].…”

“…Communication issues resulting from physician-patient language discordance are known to influence health care satisfaction [5][6][7][8]. Racial and ethnic disparities concerning access to health care are well recognized [9][10][11]. Socioeconomic status is another potential obstacle to health care delivery, even in countries with publicly funded universal health care systems [12][13][14].…”

Racial disparity in liver disease: Biological, cultural, or socioeconomic factors

“…A chart review of more than 4,000 medical charts from 4 clinic sites in Philadelphia revealed that only 32% of African Americans and 40% of Hispanics who had tested positive for HCV had documented referral to a specialist for interferon and ribavirin therapy compared to 71% of whites who tested positive for HCV. 28 Another study from Los Angeles showed that even though Hispanics were more likely to be eligible for treatment, they were less frequently initiated on therapy and more likely to prematurely end treatment. 25 Disparities in rates of referral for HCV therapy are further compounded by racial differences in response rate to interferon-based therapy.…”

Chronic hepatitis C in the Latino population

“…What is troublesome is that even in well-identifi ed high-risk populations, documentation of HCV infection is infrequent and referrals for therapy are rare. Trooskin et al [ 43 ], in the recent publication of their study designed to determine rates of HCV risk factor ascertainment, testing, and referral from four primary care sites in Philadelphia, reported on the effect of race and ethnicity. They found that in urban primary care, documentation of an HCV risk factor history was uncommon.…”