Specialty Care and Education in Patients With Chronic Hepatitis C
Specialty Care and Education in Patients With Chronic Hepatitis C
Background: Little is known about differences among hepatitis C virus (HCV) patients managed by generalists vs. specialists with respect to patient-centred outcomes, such as disease-specific knowledge, health-related quality of life (HRQoL) and satisfaction with care.
Aim: To examine selected patient-centred outcomes of HCV-related care provided in primary care, specialty care or both.
Methods: A total of 629 chronic HCV patients completed a survey including an HCV knowledge assessment and validated instruments for satisfaction and HRQoL. Multivariable linear regression was used to compare outcomes between groups.
Results: Adjusted total HCV knowledge score was lower among patients who did not attend specialty care (P < 0.01). Primary care and specialty patients did not differ in adjusted general HRQoL or satisfaction. Sixty percent of specialty patients underwent formal HCV education, which was associated with 5% higher knowledge score (P = 0.01). General HRQoL and patient satisfaction did not differ between primary care and specialty groups. Disease-specific knowledge and care satisfaction were independent of mental illness, substance abuse, socio-economic variables, history of antiviral treatment, formal HCV education and duration of time between last visit and survey completion.
Conclusions: Primary care patients with chronic HCV have lower adjusted disease-specific knowledge than specialty patients, but no difference in general HRQoL or patient satisfaction.
Over 4.1 million Americans have been infected by the hepatitis C virus (HCV), including 1.3% of the general population and 5.4% of Veterans Affairs (VA) medical centre users. Nationally, 60–77% of chronic HCV patients are followed up by specialists in gastroenterology, hepatology or infectious disease, whereas the rest are managed by primary care providers. It is known that HCV patients place significant emphasis on provider communication as a determinant of their experience with care. However, it is not known whether management of chronic HCV by primary care or specialty providers is associated with differences in patient-centred outcomes such as disease-specific knowledge, satisfaction with care or quality of life. Understanding differences between patients who remain within primary care and those who attend specialty care may provide insight into patient-centred differences and can reflect differences between general and specialty medical care.
Chronic HCV is an indolent disease that requires long-term monitoring and ongoing provider relationships. Large national surveys consistently show that patients consider medical providers to be their most trusted source of medical information. Dissemination of HCV-specific knowledge can be critical to public health efforts to prevent disease transmission (e.g. avoidance of sharing of needles) and progression (e.g. avoidance of alcohol or other hepatotoxic substances); yet, the relationship between chronic HCV patients and their providers is often complex and fraught with communication difficulties. Patient centred outcomes reflect patients' well-being and can shape their ability to care for themselves and to make informed health care choices. If HCV-related education or care from specific specialties improves outcomes, management of chronic HCV may potentially benefit from incorporating such practices more fully.
Summary and Background
Background: Little is known about differences among hepatitis C virus (HCV) patients managed by generalists vs. specialists with respect to patient-centred outcomes, such as disease-specific knowledge, health-related quality of life (HRQoL) and satisfaction with care.
Aim: To examine selected patient-centred outcomes of HCV-related care provided in primary care, specialty care or both.
Methods: A total of 629 chronic HCV patients completed a survey including an HCV knowledge assessment and validated instruments for satisfaction and HRQoL. Multivariable linear regression was used to compare outcomes between groups.
Results: Adjusted total HCV knowledge score was lower among patients who did not attend specialty care (P < 0.01). Primary care and specialty patients did not differ in adjusted general HRQoL or satisfaction. Sixty percent of specialty patients underwent formal HCV education, which was associated with 5% higher knowledge score (P = 0.01). General HRQoL and patient satisfaction did not differ between primary care and specialty groups. Disease-specific knowledge and care satisfaction were independent of mental illness, substance abuse, socio-economic variables, history of antiviral treatment, formal HCV education and duration of time between last visit and survey completion.
Conclusions: Primary care patients with chronic HCV have lower adjusted disease-specific knowledge than specialty patients, but no difference in general HRQoL or patient satisfaction.
Background
Over 4.1 million Americans have been infected by the hepatitis C virus (HCV), including 1.3% of the general population and 5.4% of Veterans Affairs (VA) medical centre users. Nationally, 60–77% of chronic HCV patients are followed up by specialists in gastroenterology, hepatology or infectious disease, whereas the rest are managed by primary care providers. It is known that HCV patients place significant emphasis on provider communication as a determinant of their experience with care. However, it is not known whether management of chronic HCV by primary care or specialty providers is associated with differences in patient-centred outcomes such as disease-specific knowledge, satisfaction with care or quality of life. Understanding differences between patients who remain within primary care and those who attend specialty care may provide insight into patient-centred differences and can reflect differences between general and specialty medical care.
Chronic HCV is an indolent disease that requires long-term monitoring and ongoing provider relationships. Large national surveys consistently show that patients consider medical providers to be their most trusted source of medical information. Dissemination of HCV-specific knowledge can be critical to public health efforts to prevent disease transmission (e.g. avoidance of sharing of needles) and progression (e.g. avoidance of alcohol or other hepatotoxic substances); yet, the relationship between chronic HCV patients and their providers is often complex and fraught with communication difficulties. Patient centred outcomes reflect patients' well-being and can shape their ability to care for themselves and to make informed health care choices. If HCV-related education or care from specific specialties improves outcomes, management of chronic HCV may potentially benefit from incorporating such practices more fully.