Analyzing Patient Characteristics Associated With Hepatitis C Follow-Up Care After Implementation Of A Pharmacy Technician-Driven Service
Background: Hepatitis C is a chronic, curable, infectious disease that can lead to substantial cost burden when left untreated. Previous studies have examined models of testing and connecting patients to care for hepatitis C and why patients do not follow-up for hepatitis C care. However, no studies have looked at characteristics of patients not connected to care and characteristics associated with follow-up with and without targeted intervention. A pilot program was created through a specialty pharmacy to work on connecting patients to care for hepatitis C, and these characteristics were analyzed. Methods: Patients over the age of 18 with a positive hepatitis C RNA test from the inpatient or emergency department setting from Jan. 1, 2020 to Oct. 15, 2020 were contacted by a specialty pharmacy technician between Dec. 15, 2020 and Jan. 22, 2021. Data was retrospectively analyzed based on outcomes of technician calls and patient information from the EMR. Data points analyzed included patient demographics, test location, hospital site, time to contact, and history of HIV, substance use disorder, or any mental, behavioral, or neurodevelopmental disorder. Patient connection to care was recorded. Results: A total of 231 patients were analyzed. 39 patients (16.9%) had established follow-up prior to the technician calling. 67% of patients were not able to be contacted. There was a statistically significant association between sex and being connected to care prior to the call (χ2 = 7.534, p=0.006). Sex was independently associated with connection to care, with males 2.6 times more likely to not be connected to care (p=0.007, 95% CI (1.298, 5.315)). 35 patients were reached that were not previously connected to care with 24 (68.6%) connected to care. There was a statistically significant interaction between insurance status and being connected to care (Fisher’s Exact Test, p=0.004). Additionally the patients who were more likely to be connected to care were contacted in average 1.092 months later (6.38 +/- 2.98) compared to those who did not get connected to care (5.27 +/- 2.24 months) (t(33)=-1.092, p=0.029). Insurance status was significantly associated with not being connected to care after the intervention, with self-pay patients 12.2 times more likely to not get connected to care (p=0.004). Discussion: This study highlights that having a dedicated resource to care coordination helps to increase the proportion of patients connected to care. Additionally, pharmacy technicians have the skillset to effective be in this role. Limitations of the study include a small sample size, inability to contact many patients, and relying on accuracy of data entered into the EMR. Conclusion: In the setting of a non-closed, large health system with multiple sites, a centralized resource to facilitate care coordination efforts may be beneficial in increasing the number of patients connected to care for hepatitis C. Based on the results, male patients should have an increased focus on connecting to care and tools need to exist to connect self-pay patients to care.
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