Starting hepatitis C treatment during acute care hospitalizations: A qualitative study of barriers and facilitators.

Abstract

Background: Hepatitis C (HCV) is a chronic, prevalent disease that disproportionately affects people who use drugs in the United States. One strategy to decrease HCV prevalence is the initiation of treatment during hospitalization. Factors affecting the success of this approach are not well-characterized in the literature. Subspecialty providers in fields that treat substantial numbers of patients with HCV are well-positioned to describe factors affecting treatment provision.

Objectives: To understand barriers and facilitators of inpatient hepatitis C treatment from the perspectives of subspecialty physicians in the United States.

Methods: In this qualitative research study, we interviewed 20 infectious diseases, hepatology, and addiction medicine physicians at 12 medical institutions across the United States. We analyzed interviews using a rapid matrix technique.

Results: Four major themes emerged: (1) hospitalization can be a gateway to care for patients who otherwise might not receive HCV treatment; (2) patients are vulnerable to being lost to follow-up in the transition from inpatient to outpatient care; (3) the inpatient payment model is a barrier to widespread implementation of programs to treat HCV during hospitalization; and (4) treatment protocols and project "champions" can support inpatient HCV treatment initiatives.

Conclusions: Physicians view hospitalization as an opportunity for patients to start HCV treatment. However, they have concerns about patients becoming lost to follow-up after hospital discharge. Interviewees perceived that these concerns could be mitigated by implementing standardized protocols for HCV treatment with clear process ownership, as well as by dedicated funding for care navigators and systems champions. Lastly, physicians report that insurance coverage and reimbursement present major barriers to inpatient HCV treatment initiation.