BMC Public Health 2006, 6:3 http://www.biomedcentral.com/1471-2458/6/3 Table 2: Referral pathways of HCV patients to comprehensive service providers Source of referral for patients with established HCV diagnosis to the CSP • Primary care • Prison • DAT • GUM • Hepatology • Gastroenterology • ID • Other • Primary care • Prison • DAT • GUM • Hepatology • Gastroenterology • ID • Other Source of referral when HCV diagnosed by the CSP *Totals can exceed 100% as more than one response themselves provide such a service. Of these, 65% (37/57) responded giving a total response rate of 70% (240/344). 40% (97) of respondents were comprehensive service pro- viders (CSPs). 46 (47%) of the CSPs had a gastroenterol- ogy lead, 36 (37%) a hepatology lead, and 15 (16%) an ID lead. GUM physicians provided a service up to DIP 26 (26%), but none were CSPs. Almost three-quarters of hepatologists and half of ID phy- sicians were CSPs. The majority of gastroenterologists (63%) provided either no role or a DIP service for patients with HCV (see Table 1). DIPs were mostly sited in small or medium sized district hospitals with an urban/mixed urban catchment popula- tion. Most looked after a small number of patients with HCV infection, with 52% diagnosing less than 10 patients with HCV (2001) and 82% diagnosing less than 20 patients. More of the CSPs covered catchment populations of over 1 million (15%) compared to DIP (8%), with more of the largest catchment areas being served by hepatologists (p = 0.006). CSPs saw a larger new caseload with 50% of respondents seeing >40 patients a year. The total estimated prevalent population of patients with CHC managed by the responding CSPs was 22,100, of which 50% were managed by hepatologists, and 25% each by ID physicians and gastroenterologists. The % of CSPs* 41 14 24 14 0 10 5 12 % of CSPs 73 4 14 6 3 17 12 14 number of prevalent patients varied between CSPs, the median number was in the range 100–500 patients; at the extremes nine CSPs managed under 20 cases in total and three CSPs were managing over 1000 patients in total. (There may be some uncertainty in who is included in these figures, as the questionnaire asked for patient num- bers "currently under your care" which may include those defaulting and not yet discharged back to Primary Care). One third of CSPs saw >75 new cases of HCV in 2001. Identification and referral of HCV patients (Table 2) For half of the CSPs the diagnosis of HCV infection was already made at the time of referral. Of patients referred with an established diagnosis, 41% originated in primary care, 24% in drug and alcohol services, 14% in prison healthcare and 14% from GUM physicians. Of those referrals where the CSP unit established the diag- nosis of Hepatitis C, most came from primary care (73%), other clinical specialties (mainly gastroenterology (17%) and ID (12%)), and drug and alcohol agencies (14%). 50% (48) of CSPs were aware of active case finding in their catchment populations, with 19% (9) of case finding being performed in accordance with a written policy. Most case finding was performed in patients with abnor- mal liver tests, or with identified risk factors such as IDU. 24% (22) of CSPs had outreach services, most commonly in prisons (17) or drug and Alcohol services (9). Page 3 of 9 (page number not for citation purposes)