Asynchronous electronic consultation between primary care and specialized care proved effective for continuum of care for viraemic hepatitis C patients.

INTRODUCTION: 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.

Retrieval and treatment of patients with primary biliary cholangitis who are lost in the health system.

INTRODUCTION: hepatitis C patients loss to follow-up in the health care system has been shown to have negative consequences. This study aimed to investigate this issue as regards primary biliary cholangitis. METHODS: the databases (immunology, biochemistry, clinical reports, drug dispensation, appointments) of 4 reference hospitals in Spain (serving a population of 1,450,000 inhabitants) were analyzed. The diagnosis of primary biliary cholangitis was based on an antimitochondrial antibody titer ≥ 1:80, chronically elevated alkaline phosphatase, and the absence of other liver disease. Patients were classified as lost in the absence of reports indicating a diagnosis, specific medical follow-up, and/or treatment with bile salts. RESULTS: a total of 1372 patients with antimitochondrial antibody titers ≥ 1:80 were included between January 2010 and June 2019. A total of 697 (50.8 %) were classified as having primary biliary cholangitis, and 100 patients (14.3 %; 95 % CI: 11.8-17.2) were identified as lost. Of these, 30 were contacted and retrieved. The median age was 70 years, 93 % were female, median alkaline phosphatase was 185 IU/L, 10 % had pruritus, and 27 % had a transient elastography value > 9.5 kPa. The disease was confirmed and ursodeoxycholic acid was started in all 30 patients. Death was liver-related in 6 of the 100 patients classified as lost. CONCLUSION: up to 14.3 % of patients (1 out of 7) with a definitive diagnosis of primary biliary cholangitis remain undiagnosed, thus preventing monitoring and treatment. More than a quarter are at risk of advanced liver disease and its complications. Patients lost in the system must be identified and retrieved, and searching hospital databases is a suitable approach to meet this goal.

Asynchronous electronic consultation between primary care and specialized care proved effective for continuum of care for viraemic hepatitis C patients / La consulta electrónica asíncrona entre atención primaria y atención especializada resultó eficaz para la continuidad de la atención a los pacientes con hepatitis C virémica

Introduction: 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.(AU)

Introducción: 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.(AU)