Low Clinic Attendance Rates for Hepatitis C Appointments at UMCNO
Publication Date
July 2019
Location
LSU Health Medical Education Building
Document Type
Abstract
Start Date
26-7-2019 9:00 AM
End Date
26-7-2019 12:00 PM
Description
Background: Hepatitis C virus (HCV) is a single-stranded RNA virus and often contracted through the use of unsterile needles and syringes during the course of IVDU and blood transfusion. The infection is also less commonly contracted during sexual intercourse (Modi and Liang, 2008). Chronic Hepatitis C is typically asymptomatic. When left untreated, the infection can lead to cirrhosis, hepatocellular carcinoma, liver failure, and death (Poll et al., 2017). This highlights the importance of early clinic appointments and treatment. At the Emergency Department (ED) of UMCNO, 178 patients of the 297 patients who tested positive for HCV and were referred for a clinic appointment in 2017 failed to keep that clinic appointment. This study aims to identify patient specific and clinical variables that correlate to low and high attendance rates. Methods: We conducted a retrospective chart review of 632 patients who were 18 years or older diagnosed with HCV at the UMCNO ED between January 1, 2017 and May 31, 2019. Medical charts were reviewed to obtain demographic and clinical variables pertaining to various patient groups with Hepatitis C infection to assess correlations with low and high clinic attendance rates. Results: Our results showed that 75% of subjects were males. 48.4% were black, 45.4% were white, and 6.17% were other. There is a significant correlation between age (p-value= 0.0002), race (black vs white: p-value= 0.0521; other vs white: p-value= 0.0129), and drug usage (p-value= 0.0083) with attendance to the first infectious disease (ID) clinic appointment. There was no significant correlation between counseling by testing nurses, follow-up phone calls, and social work intervention and first ID clinic appointment. Average time to linkage was 115 days. The average time to linkage in 2017 was 188 days, and the average time to linkage in 2018 was 81 days, demonstrating a 57% reduction in time from diagnosis to first appointment. There were 69 fewer appointments scheduled in 2018 than in 2017. Analyzing data across these years, we saw linkage within one-month increase by a factor of 7 (with 3 out of 67 in 2017 and 15 out of 48 in 2018 linked to care in a month). Conclusion: We set out to identify correlations with attendance rate and compare the attendance rate between 2017 and 2018. As age increases by one year, patients are 1.042 times more likely to attend their first appointments. Patients who use one or more drugs are 0.5 times less likely to attend their first appointments. While an older age and no drug usage were correlated to a high attendance rate, modifiable variables such as counseling, phone calls, and social work intervention were found to have no significant correlation with attendance rate. Even though fewer appointments were scheduled in 2018 compared to 2017, there was a higher first ID clinic attendance recorded in 2018. This may be impacted by the ID nurse clinic visits and the Opioid Survival Program initiated in 2018 by the ID clinic and the ED. These programs may be improving attendance rates and may need to be expanded.
Recommended Citation
Ogbuefi, Chizoba C., "Low Clinic Attendance Rates for Hepatitis C Appointments at UMCNO" (2019). Summer Research Internship Program. 28.
https://digitalscholar.lsuhsc.edu/srip/2019/undergrad/28
Low Clinic Attendance Rates for Hepatitis C Appointments at UMCNO
LSU Health Medical Education Building
Background: Hepatitis C virus (HCV) is a single-stranded RNA virus and often contracted through the use of unsterile needles and syringes during the course of IVDU and blood transfusion. The infection is also less commonly contracted during sexual intercourse (Modi and Liang, 2008). Chronic Hepatitis C is typically asymptomatic. When left untreated, the infection can lead to cirrhosis, hepatocellular carcinoma, liver failure, and death (Poll et al., 2017). This highlights the importance of early clinic appointments and treatment. At the Emergency Department (ED) of UMCNO, 178 patients of the 297 patients who tested positive for HCV and were referred for a clinic appointment in 2017 failed to keep that clinic appointment. This study aims to identify patient specific and clinical variables that correlate to low and high attendance rates. Methods: We conducted a retrospective chart review of 632 patients who were 18 years or older diagnosed with HCV at the UMCNO ED between January 1, 2017 and May 31, 2019. Medical charts were reviewed to obtain demographic and clinical variables pertaining to various patient groups with Hepatitis C infection to assess correlations with low and high clinic attendance rates. Results: Our results showed that 75% of subjects were males. 48.4% were black, 45.4% were white, and 6.17% were other. There is a significant correlation between age (p-value= 0.0002), race (black vs white: p-value= 0.0521; other vs white: p-value= 0.0129), and drug usage (p-value= 0.0083) with attendance to the first infectious disease (ID) clinic appointment. There was no significant correlation between counseling by testing nurses, follow-up phone calls, and social work intervention and first ID clinic appointment. Average time to linkage was 115 days. The average time to linkage in 2017 was 188 days, and the average time to linkage in 2018 was 81 days, demonstrating a 57% reduction in time from diagnosis to first appointment. There were 69 fewer appointments scheduled in 2018 than in 2017. Analyzing data across these years, we saw linkage within one-month increase by a factor of 7 (with 3 out of 67 in 2017 and 15 out of 48 in 2018 linked to care in a month). Conclusion: We set out to identify correlations with attendance rate and compare the attendance rate between 2017 and 2018. As age increases by one year, patients are 1.042 times more likely to attend their first appointments. Patients who use one or more drugs are 0.5 times less likely to attend their first appointments. While an older age and no drug usage were correlated to a high attendance rate, modifiable variables such as counseling, phone calls, and social work intervention were found to have no significant correlation with attendance rate. Even though fewer appointments were scheduled in 2018 compared to 2017, there was a higher first ID clinic attendance recorded in 2018. This may be impacted by the ID nurse clinic visits and the Opioid Survival Program initiated in 2018 by the ID clinic and the ED. These programs may be improving attendance rates and may need to be expanded.
Comments
Mentor: Lisa Moreno-Walton MD, MS, MSCR, FAAEM, UMCNO Emergency Department