Healthcare and social assistance utilization in persons participating in hepatitis C treatment and harm reduction programs through the RECAP clinic

Background: The Center for Research, Education, and Clinical Care of at-Risk Populations (RECAP) is based in New Brunswick, Canada (NB), and provides community-based care that includes addictions management and HCV treatment. To better understand the impact of this care model we established the Hepatitis C Positive and At-Risk (HEAR) Registry.

Methods: The current study assessed healthcare and social service utilization in patients in the HEAR registry between 2014 and 2021. Registry cases were compared to controls matched by sex, birth year, and postal code. Our analysis includes HCV positive and uninfected patients, persons who have undergone HCV treatment, and opiate and polysubstance users.

Outcomes assessed included mean hospital admissions, length of stay, physician and emergency room (ER) visits, mean prescription drug costs, and utilization of social assistance (SA). Outcomes were assessed prior to enrollment, within the first year of enrollment, and post enrollment into our program.

Results: Registry patients were younger and more likely to be on social assistance than controls. They were more likely to be male and live in high poverty areas. They were more likely to have been in federal or provincial prison, and almost twice as likely to have two or more chronic diseases.

Overall healthcare utilization in HEAR patients is higher, including more hospitalizations, longer lengths of stay, physician and ER visits, and medication cost. Hospital incidence declined in the first year following RECAP enrollment before returning to pre-enrollment levels. Physician and ER visits showed a temporary increase in the first year following enrollment. Medication costs declined across the time periods in our study. The incidence of receiving SA declined during and after enrollment into the registry.

Conclusion: RECAP enrollment and care impacted healthcare and SA utilization. Data will be presented for patients who underwent HCV treatment, and for persons with opiate and polysubstance use. 

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