Improving Access to Hepatitis C Care for Urban, Underserved Patients Using a Primary Care-Based Hepatitis C Clinic

Miller, Lesley; Fluker, Shelly‐Ann; Osborn, Melissa; Liu, Xiaoxia; Strawder, Akilah

doi:10.1016/s0027-9684(15)30161-9

Cited by 18 publications

(22 citation statements)

References 19 publications

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“…The trends in urban–rural health disparities may be affected by demographic transitions, such that some rural areas have become more isolated as more people move into urban areas. Several explanations for urban–rural disparities in adverse birth outcomes have been suggested including higher prevalence of smoking, health care inequalities, and increased exposure to environmental hazards [12-16]. Taken together, these results suggest low socioeconomic status (SES) African American individuals in inner city and rural areas may be particularly vulnerable to adverse birth outcomes.…”

Section: Introductionmentioning

confidence: 95%

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

Kent

McClure

Zaitchik

et al. 2013

BMC Pregnancy Childbirth

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BackgroundSignificant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban–rural status.MethodsAlabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined.ResultsPopulation dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991–2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors.ConclusionsPopulation dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching isolated rural areas.

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Section: Introductionmentioning

confidence: 95%

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

Kent

McClure

Zaitchik

et al. 2013

BMC Pregnancy Childbirth

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“…In order to address lack of access to specialists, models involving close collaboration between primary care practitioners and subspecialists also through telemedicine and multidisciplinary networks of specialists have been implemented [65, 78, 79]. Furthermore, the decreased duration and better safety profile of current HCV therapy may increase the number of mid-level practitioners and primary care physicians able to appropriately manage and treat HCV infection [35].…”

Section: Which Are the Perspectives For The Universal Screening Ofmentioning

confidence: 99%

State of the Art, Unresolved Issues, and Future Research Directions in the Fight against Hepatitis C Virus: Perspectives for Screening, Diagnostics of Resistances, and Immunization

Trucchi

Orsi

Alicino

et al. 2016

Journal of Immunology Research

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Hepatitis C virus (HCV) still represents a major public health threat, with a dramatic burden from both epidemiological and clinical points of view. New generation of direct-acting antiviral agents (DAAs) has been recently introduced in clinical practice promising to cure HCV and to overcome the issues related to the interferon-based therapies. However, the emergence of drug resistance and the suboptimal activity of DAAs therapies against diverse HCV genotypes have been observed, determining treatment failure and hampering an effective control of HCV spread worldwide. Moreover, these treatments remain poorly accessible, particularly in low-income countries. Finally, effective screening strategy is crucial to early identifying and treating all HCV chronically infected patients. For all these reasons, even though new drugs may contribute to impacting HCV spread worldwide a preventive HCV vaccine remains a cornerstone in the road to significantly reduce the HCV spread globally, with the ultimate goal of its eradication. Advances in molecular vaccinology, together with a strong financial, political, and societal support, will enable reaching this fundamental success in the coming years. In this comprehensive review, the state of the art about these major topics in the fight against HCV and the future of research in these fields are discussed.

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“…1 Urban safety-net hospitals, serving large populations of patients with substance use disorders, are prime locations for treating HCV-infected patients. Knowing that physicians in primary care settings can deliver care to patients infected with HCV is important for expanding treatment, 2 and models of primary care treatment delivery in the era of newer oral HCV medications are needed.…”

mentioning

confidence: 99%

“…Prior studies [2][3][4] have demonstrated that general internists can successfully deliver HCV care for urban underserved patients in primary care settings. We are unaware, however, of primary care treatment programs in the era of newer oral medications.…”

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confidence: 99%

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A Hepatitis C Treatment Program Based in a Safety-Net Hospital Patient-Centered Medical Home

et al. 2017

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Hepatitis C virus (HCV) infection is a major public health problem. Urban safetynet hospitals are a prime location for HCV treatment delivery. Showing that physicians in primary care settings can deliver HCV infection care is important to expand treatment; models doing so in the era of newer oral HCV medications are needed. This article describes an innovative and successful HCV primary care treatment program in a patient-centered medical home based at an urban, safety-net hospital. The program is public health oriented in that a central team member is a public health social worker who performs population management and addresses underlying social determinants of health to facilitate engagement in HCV treatment. Other team members include general internists trained to treat HCV infections, a pharmacist, and a pharmacy technician. The program is funded with revenue generated by the 340b drug discount program, which allows providers to generate revenue when patients fill prescriptions at pharmacies in safety-net settings, as insurance reimbursements for medications exceed the cost at which safety-net providers purchase medications. During the course of 1 year, the program received 302 referrals. Of these approximately 23% have received treatment.

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Improving Access to Hepatitis C Care for Urban, Underserved Patients Using a Primary Care-Based Hepatitis C Clinic

Cited by 18 publications

References 19 publications

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

State of the Art, Unresolved Issues, and Future Research Directions in the Fight against Hepatitis C Virus: Perspectives for Screening, Diagnostics of Resistances, and Immunization

A Hepatitis C Treatment Program Based in a Safety-Net Hospital Patient-Centered Medical Home

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