Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response

Hepatitis C (HCV) is the most common chronic blood-borne disease and the leading cause of liver transplantation in the US, affecting an estimated 3.2 million Americans 1, 2. Recent advancement in antiviral treatment options has significantly increased the response rates to anti-HCV therapy even among the difficult to treat populations 3, 4. Despite this, it is estimated that only 34–48% of chronic carriers are referred for liver specialist assessment 5–7, and less than 37% of patients receive treatment for hepatitis C 6–8. Therefore, instituting models of care that have the potential to overcome barriers and improve access to care represents a critical goal in addressing the HCV epidemic 9. The Institute of Medicine recently released a report identifying “missed opportunities” in the prevention and control of HCV, and specifically recommended the development, coordination, and evaluation of education programs targeting at-risk populations, as well as improved coordination of hepatitis care delivery services in its national strategy to improve hepatitis care services 10. In addition, the American Association for the Study of Liver Diseases (AASLD) and Centers for Disease Control and Prevention (CDC) joint conference proceedings on viral hepatitis emphasized the importance of a multidisciplinary approach to HCV care and HCV care coordination, including linkage of infected persons with care and treatment services to improve prevention of viral hepatitis and the effectiveness of treatment 8. Patients within the safety-net healthcare systems that predominantly serve the uninsured and underinsured populations are especially at risk for experiencing health disparities, have limited access to care, and represent a growing vulnerable patient population 11. HCV patient education is associated with positive outcomes in various models of HCV care, including increased disease-specific knowledge 12, 13, interest in treatment 14, willingness to accept treatment 5, 15, and increase liver specialty care clinic attendance 12, 13. In a prior study within the San Francisco safety-net healthcare system, formal HCV education by liver specialists not only resulted in a significant improvement in HCV knowledge among patients, but appeared to create efficiencies in this healthcare system to allow better access to specialty care for these individuals 13. Therefore, this patient-centered approach has the potential to impact HCV management, interest in receipt of HCV treatment, and treatment outcome. However, the impact of formal HCV education by specialists on facilitating HCV treatment initiation, adherence to treatment, and treatment outcome is not clearly understood. Furthermore, although primary care providers have a pivotal role in identifying patients with HCV, referring patients to specialty consultants for treatment, and collaborating with specialty care providers 16; whether formal patient education by a specialist has a positive impact on HCV co-management between primary and specialty care providers has not been previously studied. Considering the increasing emphasis on systemic improvements to our healthcare delivery system and enhanced coordination of health services, this study was conducted to evaluate the impact of the institution of a mandatory formal HCV education class by liver specialty providers on HCV treatment initiation and outcomes and to evaluate provider attitudes towards the impact of formal patient education on HCV management.