Reasons for missed appointments with a hepatitis C outreach clinic: A qualitative study

Poll, Ray; Allmark, Peter; Tod, Angela

doi:10.1016/j.drugpo.2015.12.027

Cited by 17 publications

(37 citation statements)

References 18 publications

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“…In the HBM, perceived barriers to care are one of the strongest predictors of health behavior [36]. Housing instability, unreliable transportation, drug and alcohol use, and lack of insurance have all been previously identified to be barriers to care [12][13][14][15][16][17][18][19]37] and were common in our population. Lack of insurance and financial status were commonly perceived to be barriers, despite our clinic's ability to access treatment for all patients, regardless of insurance status.…”

Section: Discussionmentioning

confidence: 99%

“…The nurse navigator maintained a database including reason for not linking to care, as perceived by the nurse navigator, and the most common reasons provided included multiple no-shows to scheduled appointments, inability to contact patients to schedule an initial visit, and incarceration [17]. The reasons for missed appointments for HCV care are often complicated and diverse [18], incorporating patientrelated, provider-related, and health system-related barriers [19].…”

Section: Introductionmentioning

confidence: 99%

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A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South

et al. 2020

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Background Most people diagnosed with hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban Southern United States. Methods We conducted a survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify key factors influencing patient perceptions regarding HCV and pursuit of care. Results Over half of previously referred patients (N = 200) could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Based on survey responses, unreliable transportation, unstable housing, substance use, and lack of insurance were common. Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis of semi-structured interviews, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one’s own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care. Conclusions Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South

et al. 2020

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“…In the Past Month (18) In Past Year 4 (36) Treatment for Substance Use Disorder Any prior treatment 6 (55) Alcohol 2 (18) Drug Use 3 (36) Both 1 (9) No prior treatment 5 45a Housing instability de ned as moving 2 or more times in the past 6 months or concerned about housing stability in the upcoming 6 months. (Rollins 2012, Cox 2016)…”

Section: Characteristic N (%)mentioning

confidence: 99%

“…The most common reasons provided for not linking to care included multiple no-shows to scheduled appointments, inability to contact patients to schedule an initial visit, and incarceration. The reasons for missed appointments for HCV care are often complicated and diverse (18), incorporating patient-related, provider-related, and health system related barriers (19).…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

Sherbuk

Tabackman

McManus

et al. 2020

Preprint

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Background: Most people diagnosed with Hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban southern United States. Methods: We conducted a survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify key factors influencing patient perceptions regarding HCV and pursuit of care.Results: Over half of previously referred patients (N=200) could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Based on survey responses, unreliable transportation, unstable housing, substance use, and lack of insurance were common. Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis of semi-structured interviews, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one’s own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care.Conclusions: Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.

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“…The most common reasons provided for failure to link to care included multiple no-shows to scheduled appointments, inability to contact patients to schedule an initial visit, and incarceration. The reasons for missed appointments for HCV care are often complicated and varied (9), incorporating patient-related, provider-related, and health system related barriers (10).…”

Section: Introductionmentioning

confidence: 99%

Patient perceptions of Hepatitis C among those failing to pursue treatment: A qualitative study of barriers and facilitators to care

Sherbuk¹,

Tabackman²,

McManus³

et al. 2020

Preprint

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Background Most people diagnosed with Hepatitis C virus (HCV) have not linked to care. The patient perspective on decision-making regarding linkage to care (LTC) in the direct acting antivirals treatment era is limited. We assess perceptions that impacted the choice not to pursue care among non-urban patients in the South who failed to attend an HCV clinic appointment. Methods We conducted a demographic survey and semi-structured interview with participants referred to our HCV clinic between 2014 and 2018 who did not attend an appointment. Data collection and analyses were guided by the Health Belief Model. Results Twelve participants enrolled, including 7 men and 5 women. Barriers to care were common including being uninsured (33%), having unreliable transportation (42%), unstable housing (33%), and a history of substance use disorder requiring treatment (58%). Participants demonstrated good knowledge of HCV disease, complications, and treatment. Emerging themes regarding failure of LTC included: (1) ambivalence due to uncertainty regarding the impact of HCV on one’s own health, (2) logistical barriers such as financial concerns, lack of insurance, transportation, scheduling conflicts, (3) prior negative experiences with HCV care resulting in hesitance to seek care, (4) stigma, and (5) patient-provider relationships as a barrier when the relationship is poor and a facilitator when good. Conclusions A strong HCV knowledge base was not sufficient for participants to seek care. Strategies to increase treatment uptake by changing patient perceptions include addressing the uncertainty of how HCV impacts one’s health, acknowledging challenges with HCV treatment in the past, eliminating stigma in health care settings, and promoting education regarding treatment ease and availability. Expanding access to Medicaid may overcome perceived financial barriers. Providing HCV care in settings with an established patient-provider relationship may increase treatment uptake.

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Reasons for missed appointments with a hepatitis C outreach clinic: A qualitative study

Cited by 17 publications

References 18 publications

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban U.S. South

Patient perceptions of Hepatitis C among those failing to pursue treatment: A qualitative study of barriers and facilitators to care

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