Introduction New patients’ attendance rates at the specialist clinic for hepatitis C virus (HCV) management in Grampian are around 45% and a significant proportion of those attending fail to remain under follow-up for a variety of reasons. In an attempt to increase the number of HCV positive individuals attending specialist care, an appointment with a Hepatology Nurse Specialist at their General Practice surgery or community hospital was offered to all those previously referred, still alive and living in our Health Board area.
Aim (1). Describe the demography of those previously referred, still alive and living in the area but no longer attending specialist care; (2). Evaluate different strategies for re-engagement with Hepatitis C services; (3). Compare the demographic features of those accepting and declining offer of re-engagement.
Method Subjects were identified from the Grampian HCV database and the re-engagement exercise was conducted using three methods depending on the preference and resources of General Practice Surgeries: (1). Appointments coincided with provision of existing Methadone prescriptions; (2). Patients were telephoned and chose the time of their appointment. If patients were uncontactable by telephone, appointments were sent by post; (3). Appointments were allocated and time communicated by letter. Only one surgery linked appointments with current Methadone prescriptions. Data were analysed using PASW Statistics V.18. Characteristics of individuals under follow-up were compared to individuals requiring appointments using the Continuity corrected χ2 test for categorical data and the non-parametric Mann–Whitney test for skewed continuous data. A logistic regression model was fitted to investigate whether gender, age and Carstair's deprivation category could influence loss to follow-up. The same statistical tests were used to compare characteristics of individuals who re-engaged with those who failed to attend clinic appointments. Associations between clinic attendance and method of re-engagement were examined using the Continuity corrected χ2 test for categorical data.
Results We identified 276 patients requiring follow-up. Those lost to follow-up were significantly younger than patients under continued follow-up (median (IQR) age 34 (30–40) vs 39 (32–49)) (p<0.001). Patients under continued follow-up were more likely to live in deprivation category 1 (OR 2.50 (CI 1.07 to 5.85)) (p=0.035) and 2 (OR 2.43 (CI 1.27 to 4.62)) (p=0.007) than those lost to follow-up, although the gender distribution was similar in both groups. All 276 patients not under follow-up were offered appointments: 96 (35%) attended and 11 declined. Gender, age and deprivation category had no significant effect on re-engagement. Linking appointments with Methadone prescriptions resulted in 89% (31/35) attendance, significantly higher than arranging appointments by prior telephone discussion 43% (24/56) (p=0.009) or allocating appointments with communication by letter 24% (41/174) (p<0.001).
Conclusion Linking appointments with Methadone prescriptions was associated with significantly higher attendance than other methods although this was only possible in 13% of cases. Allocation and communication by letter resulted in very disappointing attendance rates. This study has demonstrated that a change in the traditional method of service delivery may be required for the successful re-engagement of those with hepatitis C infection and effort should be directed in linking appointments for management of Hepatitis C with their Methadone appointment in appropriate individuals.
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