P69 How to re-engage patients with Hepatitis C infection: linking to Methadone prescribing works
Authors: S. Burnett, P. Dundas, D. J. McLernon, A. Fraser
Journal: Gut (2011)

<h3>Introduction</h3> New patients’ attendance rates at the specialist clinic for hepatitis C virus (HCV) management in Grampian are around 45% and a significant proportion of those attending fail to remain under follow-up for a variety of reasons. In an attempt to increase the number of HCV positive individuals attending specialist care, an appointment with a Hepatology Nurse Specialist at their General Practice surgery or community hospital was offered to all those previously referred, still alive and living in our Health Board area. <h3>Aim</h3> (1). Describe the demography of those previously referred, still alive and living in the area but no longer attending specialist care; (2). Evaluate different strategies for re-engagement with Hepatitis C services; (3). Compare the demographic features of those accepting and declining offer of re-engagement. <h3>Method</h3> Subjects were identified from the Grampian HCV database and the re-engagement exercise was conducted using three methods depending on the preference and resources of General Practice Surgeries: (1). Appointments coincided with provision of existing Methadone prescriptions; (2). Patients were telephoned and chose the time of their appointment. If patients were uncontactable by telephone, appointments were sent by post; (3). Appointments were allocated and time communicated by letter. Only one surgery linked appointments with current Methadone prescriptions. Data were analysed using PASW Statistics V.18. Characteristics of individuals under follow-up were compared to individuals requiring appointments using the Continuity corrected χ<sup>2</sup> test for categorical data and the non-parametric Mann–Whitney test for skewed continuous data. A logistic regression model was fitted to investigate whether gender, age and Carstair9s deprivation category could influence loss to follow-up. The same statistical tests were used to compare characteristics of individuals who re-engaged with those who failed to attend clinic appointments. Associations between clinic attendance and method of re-engagement were examined using the Continuity corrected χ<sup>2</sup> test for categorical data. <h3>Results</h3> We identified 276 patients requiring follow-up. Those lost to follow-up were significantly younger than patients under continued follow-up (median (IQR) age 34 (30–40) vs 39 (32–49)) (p&lt;0.001). Patients under continued follow-up were more likely to live in deprivation category 1 (OR 2.50 (CI 1.07 to 5.85)) (p=0.035) and 2 (OR 2.43 (CI 1.27 to 4.62)) (p=0.007) than those lost to follow-up, although the gender distribution was similar in both groups. All 276 patients not under follow-up were offered appointments: 96 (35%) attended and 11 declined. Gender, age and deprivation category had no significant effect on re-engagement. Linking appointments with Methadone prescriptions resulted in 89% (31/35) attendance, significantly higher than arranging appointments by prior telephone discussion 43% (24/56) (p=0.009) or allocating appointments with communication by letter 24% (41/174) (p&lt;0.001). <h3>Conclusion</h3> Linking appointments with Methadone prescriptions was associated with significantly higher attendance than other methods although this was only possible in 13% of cases. Allocation and communication by letter resulted in very disappointing attendance rates. This study has demonstrated that a change in the traditional method of service delivery may be required for the successful re-engagement of those with hepatitis C infection and effort should be directed in linking appointments for management of Hepatitis C with their Methadone appointment in appropriate individuals.