Volume 46, Issue 4, April 2023, Pages 266-273Author links open overlay panel, , , , , , , , , , AbstractIntroduction

It has been proposed that primary care diagnose and treat hepatitis C virus (HCV) infection. However, a care circuit between primary and specialized care based on electronic consultation (EC) can be just as efficient in the micro-elimination of HCV. It is proposed to study characteristics and predictive factors of continuity of care in a circuit between primary and specialized care.

Methods

From February/2018 to December/2019, all EC between primary and specialized care were evaluated and those due to HCV were identified. Variables for regression analysis and to identify predictors of completing the care cascade were recorded.

Results

From 8098 EC, 138 were performed by 89 (29%) general practitioners over 118 patients (median 50.8 years; 74.6% men) and were related to HCV (1.9%). Ninety-two patients (78%) were diagnosed > 6 months ago, and 26.3% met criteria for late presentation. Overall, 105 patients required assessment by the hepatologist, 82% (n = 86) presented for the appointment, of which 67.6% (n = 71) were viraemic, 98.6% of known. Finally, 61.9% (n = 65) started treatment. Late-presenting status was identified as an independent predictor to complete the care cascade (OR 1.93, CI 1.71–1.99, p < 0.001).

Conclusion

Communication pathway between Primary and Specialized Care based on EC is effective in avoiding significant losses of viraemic patients. However, the referral rate is very low, high in late-stage diagnoses, heterogeneous, and low in new diagnoses. Therefore, early detection strategies for HCV infection in primary care are urgently needed.

ResumenIntroducción

Se ha propuesto que atención primaria diagnostique y trate la infección por virus de la hepatitis C (VHC). Sin embargo, un circuito asistencial entre atención primaria y especializada basado en la consulta electrónica (CE) puede ser igual de eficiente en la microeliminación del VHC. Se propone estudiar características y factores predictivos de la continuidad asistencial en un circuito entre atención primaria y especializada.

Métodos

Desde febrero/2018 y diciembre/2019 se evaluaron todas las CE entre atención primaria y especializada, y se identificaron aquellas por VHC. Se registraron variables para análisis de regresión e identificar factores predictores de completar cascada de atención.

Resultados

De un total de 8.098 CE, 138 realizadas por 89 (29%) médicos generales de 118 pacientes (mediana de 50,8 años; 74,6% varones) fueron por VHC (1,9%). Noventa y dos pacientes (78%) fueron diagnosticados hace más de 6 meses), y el 26,3% cumplía criterios de presentación tardía. En total, 105 pacientes requirieron valoración por el hepatólogo. El 82% (n = 86) se presentaron a la cita, de los cuales el 67,6% (n = 71) eran virémicos, el 98,6% de los conocidos. Finalmente, el 61,9% (n = 65) inició tratamiento. El estado de presentación tardía se identificó como un factor predictivo independiente para completar la cascada de atención (OR: 1,93; IC 95%: 1,71-1,99; p < 0,001).

Conclusión

La comunicación entre atención primaria y especializada basada en la CE es eficaz para evitar pérdidas significativas de pacientes virémicos. Sin embargo, la tasa de derivación es muy baja, elevada en diagnósticos en fase tardía, heterogénea y escasa en nuevos diagnósticos. Por tanto, se necesitan con urgencia, estrategias de detección precoz de infección por VHC en atención primaria.

Section snippetsStudy design

Since 2012, primary care physicians established contact with gastroenterologists by texting the reason in a free text box within the electronic medical platform that includes PC and specialized care for this purpose. A reply by the specialist is expected before 48 h. The specialist may then ask for more information, discharge the patient, or schedule an appointment for further evaluation.

We retrospectively evaluated the total contacts by EC between 54 PC centres and the Gastroenterology

Characteristics of patients

During the study period, we registered 8098 EC of 6356 patients (median age, 56.5; range 43.6–69.4 years; men 42.3%). After excluding deaths (n = 123) and cases with duplicated EC (n = 1216) and incomplete information (n = 383), 138 contacts (20 EC were repeated) by EC for 118 patients (median age, 50.7; range 43.1–56.4 years; men 74.6%) were related to HCV (1.9%). The EC were performed by 89 out of 306 (29%) general practitioners (Fig. 1).

In particular, the presence of a positive anti-HCV test

Discussion

Our study shows that a significant proportion of HCV viraemic patients referred from PC to specialized care after establishing contact through EC were successfully linked to care without substantial losses along the cascade of care. Furthermore, EC allows for relinking of patients who were lost to follow-up as the majority of patients were long diagnosed before the referral.

Despite the desire to eliminate HCV by 2030, it would only be a reality if screening efforts are associated with linkage

Funding

This study was supported in part by grants from Fondos FEDER. Dr. M. Hernández-Guerra is the recipient of a Grant from Instituto de Salud Carlos III (PI19/01756).

Conflict of interest

Dr. M. Hernández-Guerra has received research grants from AbbVie and Gilead. Dr. D. Morales-Arráez has received a research grant from Gilead sponsored by the Spanish Association for the Study of the Liver (AEEH). All other authors have no conflicts of interest to declare.

Acknowledgements

We thank BIOAVANCE and CIBICAN for their editorial support.

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