TUESDAY, Aug. 17 (HealthDay News) -- Nationwide, the quality of care provided to patients with hepatitis C virus (HCV) infection is substantially below proposed Medicare standards, though care that involves both specialists and generalists is associated with the highest quality, according to a study in the Aug. 17 issue of the Annals of Internal Medicine.
Fasiha Kanwal, M.D., of the John Cochran Veterans Affairs Medical Center in St. Louis, and colleagues evaluated the care received by 10,385 patients with HCV (mean age, 47.9 years) enrolled in a national health insurance company database. The researchers used quality-of-care indicators from Medicare's 2009 Physician Quality Reporting Initiative, which recommended confirmation of HCV viremia, hepatitis A and B vaccinations, antiviral therapy, testing for genotype and viral load before treatment, and testing for viral load after 12 weeks of therapy.
The researchers found that the proportion of patients meeting the indicators ranged from 21.5 percent for vaccination to 79 percent for HCV genotype testing, with only 18.5 percent of patients receiving all components of recommended care. Elevated liver enzyme levels, cirrhosis, and HIV infection were associated with higher-quality care, while older age and comorbid conditions were associated with lower-quality care. Patients who saw both generalists and specialists received the best quality of care.
"Health care quality, based on Medicare criteria, is suboptimum for HCV. Care that [includes] both specialists and generalists is associated with the best quality. Our results support the development of specialist and primary care collaboration to improve the quality of HCV care," the authors write.
One study author disclosed financial ties to pharmaceutical companies.
Abstract
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