P88 Follow-up of HCV patients referred to specialist services—where do they all go?
Authors: R Mcwilliam, P Dundas, A Fraser
Journal: Gut (2010)

Introduction  The Liver Service provides assessment and treatment for patients with Hepatitis C Virus (HCV) infection. Referrals are accepted irrespective of patient9s co-morbid disease, route of infection, current or past use of illicit substances. After referral, an out-patient appointment is posted with one further appointment offered if the first appointment is not attended. Patients who attend are asked to arrange follow-up appointments with reception staff immediately after the consultation. Those who fail to attend on two consecutive occasions are not offered another appointment unless they make contact or are re-referred.  Aim  The aims of this study were:  Determine the number of new hepatitis C positive patients referred, seen and still under review at the clinic within a 1 year time frame.  Identify patients no longer under follow-up and the reason for this.  Determine the number of patients who were commenced on antiviral therapy.  Method  Information for referral and attendance at clinics between April 2008 and March 2009 was obtained from the Health Intelligence Department. HCV status was confirmed by the laboratory computer system and follow-up status of patients was obtained from the patient administration system (PAS). The medical records of patients with no planned follow-up were reviewed to determine the reason for this. Information on patients who had commenced HCV antiviral therapy was obtained from the Grampian Hepatitis C database.  Results  In total 137 HCV antibody positive patients were referred to the service. 130 (95%) were HCV RNA positive, 5 (4%) were HCV RNA negative and in 2 (1%) the HCV RNA status was unknown. The median age of the HCV RNA positive patients was 34 (IQR 11.6, range 19–62), and 84 (65%) were male. Of the HCV RNA positive patients, 28 (22%) patients were never seen due to non-attendance, 102 (78%) were seen at least once and 59 (45%) are still under follow-up. The first appointment offered was attended by 56 (55%) patients. A higher proportion of males attended at least one clinic appointment 87% (73/84) compared to 63% (29/46) of females, (p=0.003). There was no statistical difference between the age of those seen and not seen. There were 43 patients no longer under continued review following their initial attendance with 31 as a result of failing to attend on more than one occasion, 1 deceased and 1 relocated. There is no documented explanation why the remaining 10 patients do not have follow-up arranged.  Of the 102 patients who attended clinic at least once, 44 (43%) were commenced onto antiviral therapy between 2008 and 2010.  Conclusion  Our clinic policy resulted in almost 80% of patients being assessed whereas only 55% would have been seen had we not offered another appointment for those who failed to attend on the first occasion. Almost half of those seen were commenced onto antiviral therapy. The reasons for failure to attend among females require further examination. Patients without a review appointment with no apparent reason will be offered a further appointment.  Only 45% of patients in this cohort are under continued review. The service is currently undergoing redesign with the aim of improving the proportion of patients attending.