Abstract
A range of barriers to care reduce access to hepatitis C treatment. We recommend investments in patient-centered care strategies to initiate and engage these vulnerable populations in treatment, such as community-based educational peer support groups. Barriers to implementing these patient-centered care strategies remain.
Am J Manag Care. 2023;29(11): In press
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Takeaway points
- We recommend investing in patient-centered care strategies.
- Patient-centered care strategies aim to activate and engage patients in care.
- One patient-centered care strategy is to utilize community-based educational peer support groups.
- Barriers to implementing educational peer support groups remain.
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The U.S. healthcare system is like a square peg in a round hole at treating hepatitis C patients. Rather than addressing the myriad characteristics that make up the whole person, healthcare providers see patients during pre-specified, inflexible hours to address a single medical problem. New technologies have transformed communication with providers; however, the structure of patient communication remains stagnant in favor of busy healthcare providers.Huge progress in hepatitis C treatment1 There is little innovation in patient experience.
Prescribing authority has been expanded to allow advanced practitioners (e.g., nurse practitioners, physician assistants) to prescribe hepatitis C treatment. Other important aspects of the patient experience—time of day, the ability to change appointments, and the check-in process—remain the same. If patients do not meet these expectations, they may be unable to initiate and participate in care. Hepatitis C patients noted other system-level barriers, such as a lack of coordination between hepatitis C treatment providers and other providers.2 Taking these factors into consideration, it is possible to understand why many people with hepatitis C do not receive treatment.
Hepatitis C treatment is particularly difficult to access in rural areas due to geographic distance, lack of public transportation, and limited number of providers.3 The current system creates additional difficulties for some patients who face social determinants of health, such as working parents, people who rely on others for transportation, and people who work inconsistent hours.4 It does not include people who have internal barriers to arriving for appointments. These multifaceted barriers must be addressed.
patient-centered care
We propose restructuring the healthcare system to put the whole patient at the center. Our current system could use some modifications to provide patient-centered care by increasing access and improving overall well-being. There is growing interest in research areas that provide low-barrier, patient-centered care for hepatitis C treatment.5 Patient-centered care includes a variety of patient care strategies; we focus on some important improvements in the health care system.
Practitioners, researchers, and patient groups are interested in using peer support to improve treatment outcomes.5.6 In one proposed model, a group of peers initiating hepatitis C treatment gather together to receive educational materials and provide mutual support and accountability throughout treatment. The course could include a small group of patients who receive education from trained medical staff on general health, HCV transmission, and other infectious processes related to hepatitis C risk behaviors (e.g., intravenous drug use). In addition, health care providers can provide education about hepatitis C treatment and expectations for patient involvement in the treatment process, including the importance of follow-up laboratory testing and related instructions. These peer support groups can be delivered in low-threshold settings (such as community centers) or via mobile devices.7
It is also important to address barriers to complementary care; for example, by allowing extended appointment times, accommodating late arrivals or no-shows (e.g., 30-minute grace period, walk-in appointments, repeat appointments, video or phone visits), and streamlining screening and referrals to reduce appointments Inflexibility of attendance. co-morbid processes, such as substance use disorders,8 Address check-in difficulties and transportation issues (e.g., telehealth), and use literacy-appropriate education (e.g., storytelling).9
To successfully implement these strategies, system-level barriers need to be addressed, such as lack of insurance coverage, stigma, unequal access to community space and/or technology in rural settings, and lack of treatment during incarceration. Future research is needed to evaluate the effectiveness, scalability, and acceptability of patient-centered interventions to treat hepatitis C targeting specific needs, such as those involved in the criminal justice system,10 An increasing proportion of women and people living in rural areas are living with hepatitis C.
System-level changes are needed to reduce barriers to hepatitis C treatment in the United States. We recommend investments in patient-centered care strategies to initiate and connect these vulnerable populations to treatment.
Author’s Affiliation: Maine Center for Integrative Health (EB), Augusta, ME; Department of Behavioral and Social Sciences, Brown University School of Public Health (AB), Providence, RI.
Sources of funds: not any.
Author disclosure: Elizabeth Bailey reports on her past service on the American Liver Foundation’s New England Division Medical Advisory Committee and involvement on the AbbVie Public Health Division’s Medical Advisory Committee. The views and opinions expressed in this review are those of the author and do not necessarily reflect the views or positions of any affiliated entity.
author information: Conception and design (EB, AB); Acquisition of data (AB); Analysis and interpretation of data (AB); Drafting the manuscript (AB); Critical revision of the manuscript for important intellectual content (EB); and Supervision (EB).
mailing address: Amelia Bailey, MPH, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-3, Providence, RI 02912. Email: amelia_bailey@brown.edu.
refer to
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