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Predictors of linkage to care for a nontargeted emergency department hepatitis C screening program.
- Source :
-
The American journal of emergency medicine [Am J Emerg Med] 2020 Jul; Vol. 38 (7), pp. 1396-1401. Date of Electronic Publication: 2019 Nov 29. - Publication Year :
- 2020
-
Abstract
- Objective: We implemented a nontargeted, opt-out HCV testing and linkage to care (LTC) program in an academic tertiary care emergency department (ED). Despite research showing the critical role of ED-based HCV testing programs, predictors of LTC have not been defined for patients identified through the nontargeted ED testing strategy. In order to optimize health outcomes for patients with HCV, we sought to identify predictors of LTC failure.<br />Methods: This was a retrospective cohort study of adult patients who were tested for HCV in the ED between August 2015 and September 2018 and were confirmed to have chronic HCV infection through RNA testing. We used logistic regression to assess the relationship between candidate predictors and the primary outcome, LTC failure, which was defined as a patient not being seen by an HCV treating provider after discharge from the ED.<br />Results: Of 53,297 patients tested, 1,674 (3.1%) had HCV on confirmatory testing, and 355 (21%) linked to care. Predictors of LTC failure included younger age (OR 0.96, 95% CI 0.95-0.97), white race (OR 1.65, 95% CI 1.23-2.22), homelessness (OR 1.91, 95% CI 1.19-3.08), substance use (OR 1.77, 95% CI 1.34-2.34), and comorbid psychiatric illness (OR 2.16, 95% CI 1.59-2.94). Patients with significant medical comorbidities (OR 0.57, 95% CI 0.41-0.78) or HIV co-infection (OR 0.11, 95% CI 0.03-0.46) were less likely to experience LTC failure.<br />Conclusions: One in five HCV-infected patients identified by ED-based nontargeted testing successfully linked to an HCV treating provider. Predictors of LTC failure may guide the development of targeted interventions to improve LTC success.<br />Competing Interests: Declaration of Competing Interest JAB reports funding from the National Center for the Advancement of Translational Science at the National Institutes of Health (TL1TR001418). JBR reports research funding from Gilead Sciences. RAF reports research funding from Gilead Sciences, Merck & Co., and Janssen Pharmaceutica, and has received consulting fees from AbbVie. SSC reports no conflicts of interest. LAW reports no conflicts of interest. JWG reports research funding from Gilead Sciences. EPH reports research funding from Gilead Sciences.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Age Factors
Alabama epidemiology
Cohort Studies
Comorbidity
Emergency Service, Hospital
Female
HIV Infections epidemiology
Hepatitis C Antibodies blood
Hepatitis C, Chronic blood
Hepatitis C, Chronic epidemiology
Hepatitis C, Chronic therapy
Ill-Housed Persons statistics & numerical data
Humans
Logistic Models
Male
Mass Screening
Middle Aged
RNA, Viral blood
Retrospective Studies
Substance-Related Disorders epidemiology
Continuity of Patient Care statistics & numerical data
Ethnicity statistics & numerical data
Hepatitis C, Chronic diagnosis
Mental Disorders epidemiology
Referral and Consultation statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8171
- Volume :
- 38
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The American journal of emergency medicine
- Publication Type :
- Academic Journal
- Accession number :
- 31836342
- Full Text :
- https://doi.org/10.1016/j.ajem.2019.11.034