This low vaccination rate suggests that the benefits of vaccination against other hepatitis viruses and pneumococcus have not been adequately stressed. The reported prevalences of risk factors for hepatitis C patients in Indiana appear to differ from those reported nationally. One cause for these apparent differences may be that the factors were reported not by the patients, but by providers. Patients may more readily reveal the possibility of sexual contact as a risk factor than illegal drug use. Physicians who are unaware of the inefficiency of sexual transmission may then be less likely to probe for other risk factors, such as injecting drug use.
Several limitations exist in the present study.
The random sample may contain racial bias. Patient referral to another provider was assumed to have ensured the patient s adequate medical management. Time constraints and data insufficiency limited the number of providers that could be contacted initially and the number of providers that could be re-contacted with a second fax. Many case records contained missing data fields, apparently because the reporting form submitted to the ISDH had not been properly completed. Automatic exclusion of records without a patient name or without a provider name reduced the number of patients eligible for study.