Shari S Rogal1,2,3, Rory McCarthy4, Andrea Reid5, Keri L Rodriguez6,7, Linda Calgaro8, Krupa Patel7, Molly Daley9, Naudia L Jonassaint10,11, Susan L Zickmund12,13,14. 1. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA. rogalss@upmc.edu. 2. Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, 3471 Fifth Avenue, 900 Kaufmann Building, Pittsburgh, PA, 15213, USA. rogalss@upmc.edu. 3. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. rogalss@upmc.edu. 4. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Cube 2-24, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA. 5. Gastroenterology, Hepatology, and Nutrition Section, Washington DC VA Medical Center, 50 Irving Street, NW, Room 3A-149, Washington, DC, 20422, USA. 6. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A127, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA. 7. Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite W933, 200 Lothrop Street, Pittsburgh, PA, 15213, USA. 8. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Cube 2-18, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA. 9. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Cube G-18, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA. 10. Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, 3471 Fifth Avenue, 900 Kaufmann Building, Pittsburgh, PA, 15213, USA. 11. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 12. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA, 15240-1001, USA. 13. VA HSR&D IDEAS 2.0 Center of Innovation, VA Salt Lake City Heath Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA. 14. Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
Abstract
BACKGROUND: Provider perceptions regarding barriers to and facilitators of hepatitis C (HCV) treatment initiation and adherence have not been fully evaluated in the interferon-free treatment era. New treatments have provided opportunities for non-specialists to treat HCV, underscoring the importance of understanding primary care provider (PCP) and specialist perspectives. METHODS: Based on qualitative sampling principles, 12 PCPs and 12 hepatology providers (HPs) from the VA Pittsburgh Healthcare System completed audio-recorded semi-structured interviews. Qualitative analysts coded perceived barriers and facilitators from the interviews with 100% double coding. Codes were thematized and analyzed using Atlas.ti. RESULTS: Key barriers to treatment described by HPs and PCPs included patients' substance use disorders, mental health, transportation availability, history of non-adherence, and concern about side effects. PCPs also focused on medication cost as a system-based barrier. The main facilitators of treatment initiation and adherence described by both HPs and PCPs were provider education and encouragement. HPs focused almost exclusively on provider-based facilitators, while PCPs noted patient-based facilitators including past adherence, media exposure to information about HCV medications, a desire to clear the virus, and positive feedback regarding treatment response. CONCLUSIONS: Providers generally focused on perceived patient-level barriers to HCV treatment initiation and adherence, as well as provider-level facilitators; PCPs additionally noted patient preferences and system-level issues that guide decision making regarding treatment initiation. While HPs focused almost exclusively on provider-level facilitators, PCPs additionally focused on patient-level facilitators of treatment. These data provide novel insights and suggest focusing on patient, provider, and system-level strategies to further improve HCV treatment initiation and adherence.
BACKGROUND: Provider perceptions regarding barriers to and facilitators of hepatitis C (HCV) treatment initiation and adherence have not been fully evaluated in the interferon-free treatment era. New treatments have provided opportunities for non-specialists to treat HCV, underscoring the importance of understanding primary care provider (PCP) and specialist perspectives. METHODS: Based on qualitative sampling principles, 12 PCPs and 12 hepatology providers (HPs) from the VA Pittsburgh Healthcare System completed audio-recorded semi-structured interviews. Qualitative analysts coded perceived barriers and facilitators from the interviews with 100% double coding. Codes were thematized and analyzed using Atlas.ti. RESULTS: Key barriers to treatment described by HPs and PCPs included patients' substance use disorders, mental health, transportation availability, history of non-adherence, and concern about side effects. PCPs also focused on medication cost as a system-based barrier. The main facilitators of treatment initiation and adherence described by both HPs and PCPs were provider education and encouragement. HPs focused almost exclusively on provider-based facilitators, while PCPs noted patient-based facilitators including past adherence, media exposure to information about HCV medications, a desire to clear the virus, and positive feedback regarding treatment response. CONCLUSIONS: Providers generally focused on perceived patient-level barriers to HCV treatment initiation and adherence, as well as provider-level facilitators; PCPs additionally noted patient preferences and system-level issues that guide decision making regarding treatment initiation. While HPs focused almost exclusively on provider-level facilitators, PCPs additionally focused on patient-level facilitators of treatment. These data provide novel insights and suggest focusing on patient, provider, and system-level strategies to further improve HCV treatment initiation and adherence.
Entities:
Keywords:
Addiction; Compliance; Direct-acting antivirals; Interferon-free medications; Mental health
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