Multi-Disciplinary Managed Care Networks-Lifesaving Interventions for Hepatitis C Patients

Author: Tait JM, Wang H, Stephens BP, Miller MH, McIntyre PG, Cleary S, Dillon JF

Theme: Clinical Research Year: 2016

MULTI-DISCIPLINARY MANAGED CARE NETWORKS-LIFESAVING INTERVENTIONS FOR HEPATITIS C PATIENTS Tait JM1 , Wang H 2 , Stephens BP1 , Miller MH1,2, McIntyre PG1 , Cleary S 2 , Dillon JF1,2 . NHS Tayside1 , University of Dundee2 Introduction: Successful HCV therapy depends on effective pathways of care. Over 2 decades we have developed 4 sequential models of care latterly using a multidisciplinary Managed Care Network (MCN) to improve HCV testing, care and treatment Methods: Cohort study to evaluate the effectiveness of care pathways, carried out using all HCV positive individuals tested in a geographical region between 1994 and 2014, follow up 21 years. Results: Study of 3122 HCV positive patients. They were divided into four cohorts representing different care pathways defined by their date of HCV antibody diagnosis: cohort A, pre July1999, conventional hospital outpatient management. Cohort B July 1999- June 2004, Specialist nursing at HCV treatment clinic. Cohort C July 2004-June 2009, development of MCN, new referral pathway- referrals by all health care professionals, outreach clinics. Cohort D July 2009-June 2014 MCN funded, routine dry blood spot testing in drug services and needle exchanges, increase in outreach clinics across region. From Cohort A to D; the number who accessed treatment services within 1year of diagnosis increased from 77/292 (26.3%) to 521/821 (72.9%) the rate of treatment starts within 1 year of diagnosis increased from 6/292 (2.0%) to 133/821 (16.2%) and the sustained viral response rate improved from 61.6% to 77.4%. All-cause mortality decreased from 232/688 (33.7%) in cohort A to 55/1207 (4.5%) in cohort D, multivariate analysis showed that pathway type was an independent predictor of mortality irrespective of age, sex, SVR status or HIV coinfection with pathway D having an odds ratio of 0.53(0.40-0.77 p

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