Theme: Epidemiology & Public Health Research Year: 2018
Background:
Care of patients with hepatitis C (HCV) is provided in both specialist offices and communitybased outpatient settings in New Brunswick. Specialist offices tend to be hospital-based or
among other physician offices while the community-based clinics are centered in areas
where many high risk individuals live. This study utilizes the hepatitis C positive and at-risk
(HEAR) database to analyze differences in characteristics among these two groups.
Methods:
Personal health data was collected with informed consent via questionnaires or medical
records. Baseline characteristics for all community-dwelling patients enrolled between April
2014 and April 2016 were included in the analysis.
Results:
A total of 374 patients were included (34.8% community vs. 65.2% specialist office). Patients
seen in the community setting were younger (median age 43.7 vs. 49.1 years), less likely to
have a primary care provider (p=0.007), be unemployed (p<0.001), have been incarcerated
(p=0.007) and reported sharing drug paraphernalia (p=0.025). Community clinic patients
also had significantly younger mean age at first use of alcohol (13.6 vs. 14.7 years,
p=0.044), marijuana (14.6 vs. 15.8, p=0.040), and opioids (23.9 vs. 26.5 years, p=0.036)
over those seen in specialist offices. They also had significantly higher proportions of current
use (≤ 6 months) of alcohol, marijuana, cocaine, opioids, and benzodiazepines.
Conclusion:
In Canada, specialist access for HCV is traditionally limited to a referral-based system
through a patient’s primary care provider. The key differences noted between patients in
community clinics with the option for self-referral versus those who present for visits in
specialist offices demonstrates that in areas where community clinics do not exist,
individuals from high risk groups may either not be receiving a referral or fail to present for
appointments due to physical and/or psychological barriers in the access of the specialist
offices.
Disclosure of Interest Statement:
No pharmaceutical grants were received in the development of this study. Dr. Smyth reports
grants and personal fees from Merck, Gilead and Abbvie. Dr. Webster reports grants from
AbbVie and Merck. Drs. Webster and Smyth, Ms. Materniak and Ms. Frechette report
affiliation with a non-profit organization who receives grants and/or sponsorships from
Abbvie, Gilead, and Merck.