Determinants of quality of care and treatment initiation in Medicare disabled patients with chronic hepatitis C

Abstract

Background: Aligning with a national priority to bridge health disparities in disadvantaged populations, we explored contextual determinants of pretreatment quality of care and treatment receipt of Medicare disabled patients with hepatitis C virus (HCV) infection. Methods: We used Medicare claims (2006–2009) linked to the Area Health Resource Files. Ordinal partial proportional odds and weighted modified Poisson regressions were used to model the determinants of quality care receipt and interferon-based treatment, respectively. Results: We identified 1936 Medicare disabled HCV patients, of whom 10.4% were treated with peg-interferon. Despite the high comorbidity burden among HCV disabled patients, greater engagement in care correlated with greater likelihood of quality care and treatment receipt. Conclusion: Our study highlights the need for process and linkage to care in Medicare disabled HCV patients, but future research relevant to novel interferon-free agents is needed to assess patterns of quality of care and treatment receipt in this vulnerable population.

Keywords:

• contextual analysis
• Medicare disabled
• quality of care
• substance
• substance abuse
• vulnerable population

Acknowledgements

The study was approved by the investigational review board at University of Maryland (HP-0056118). The authors would like to thank the Pharmaceutical Computing Center at the University of Maryland for data storage.

Financial & competing interests disclosure

E Onukwugha has received grant support from Bayer Healthcare Pharmaceuticals and Amgen and has performed consulting services for AstraZeneca and Janssen (a division of Johnson and Johnson. CD Mullins has received grant support from Bayer Healthcare Pharmaceuticals, Novartis, Pfizer and has performed consulting services for Amgen, Bayer Healthcare Pharmaceuticals, Bristol Myers Squibb, Regeneron and Pfizer. CD Howell has received grant support from Gilead Sciences, Inc., Bristol Myers Squibb, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai, Inc and IKARIA Laboratory Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Despite the advent of new tolerable and effective treatment regimens, the management of hepatitis C virus (HCV) will continue to face hurdles due to the high burden of comorbidities in the HCV infected [68].

• Representing almost three-quarters of all Medicare patients diagnosed with HCV, disabled patients infected with HCV and eligible for Medicare due to the Social Security Disability Insurance (<65 years of age) are an understudied population that faces numerous barriers to the availability, delivery, and quality of care and treatment.

• This study provides supporting evidence in favor of a high-quality care model of HCV evaluation and management for Medicare HCV patients with disability. Such a model should include several facilitators of quality process of care evaluation and initiating treatment.

• At the patient level, counseling, motivational interviewing and peer support groups can activate patients toward learning more about their disease, seeking assessment and initiating treatment [69,70].

• Additionally, eliciting patient’s perceptions of the ill consequences of liver disease and their effect on life goals and designing multimodal interventions to help patients move away from drug and alcohol improve positive attitudes toward treatment in this population [71,72].

• On the provider level, educating primary care physicians about HCV screening, testing, diagnosis and evaluation is significant in improving access to treatment. Education interventions have already shown that providers’ lack of knowledge about HCV management is a modifiable factor [73–75].

• On the system level, healthcare models involving collaborative multidisciplinary care (primary care, nurse, hepatologists, substance abuse and mental health specialist) and integrating primary care with the community to provide rapid access to services could also significantly raise the rate of HCV evaluations and eligibility for treatment for Medicare HCV patients with disability [69].

Notes