What
Actually
Happens
to
Patients
Newly
Diagnosed
with
Hepatitis
C Virus
Infection?
For
optimal
management,
individuals
who
are
infected
with
hepatitis
C virus
(HCV)
require
referral
to
the
care
of
a specialist.
The
objective
of
the
present
study
was
to
determine
whether
patients
newly
diagnosed
as
anti-HCV
positive
are
appropriately
referred
for
further
investigation
and
management,
and
if
not,
to
determine
why
not.
The
researchers
studied
patients
tested
for
antibodies
to
HCV
by
Nottingham
Public
Health
Laboratory
(Nottingham,
UK)
in
a 2-year
period
(2000-2002).
The
progress
of
newly
diagnosed
anti-HCV
positive
patients
into
specialist
clinics
for
further
management
was
documented.
For
patients
not
referred
for
specialist
care,
a questionnaire
was
sent
to
the
clinician
requesting
the
initial
anti-HCV
test,
to
identify
reasons
for
non
referral.
The
answers
to
these
questions
were
used
as
the
basis
for
this
published
report,
which
appears
in
the
April
2006
issue
of
The
Journal
of
Viral
Hepatitis. Results 
11,177
were
tested
for
anti-HCV;
256
(2.3%)
were
newly
diagnosed
as
being
anti-HCV
positive.
Two
percent
of
samples
sent
from
primary
care
were
anti-HCV
positive,
compared
to
18.8,
18.9
and
1.3%
sent
from
prison,
drug
and
alcohol
units,
and
secondary
care,
respectively.
About
64.3%
of
positive
patients
diagnosed
in
primary
care
were
referred
to
specialist
care,
compared
to
18.4,
42.4
and
62.6%
of
patients
diagnosed
in
the
other
three
settings.
One
hundred
and
twenty-five
(49%)
newly
diagnosed
patients
were
referred
appropriately
for
further
management.
68
of
these
attended
clinic,
45
underwent
liver
biopsy
and
26
(10%)
began
treatment.
One
hundred
and
thirty-one
patients
(51%)
were
not
referred.
In
54
cases,
there
was
no
evidence
that
the
anti-HCV
positive
result
reached
the
patient.
In
15,
referral
was
considered
but
rejected,
and
20
patients
were
referred
to
non-HCV-specialists
(their
general
practitioners
or
to
genito-urinary
medicine).
The
study
authors
conclude,
"…Less
than
50%
of
newly
diagnosed
anti-HCV
positive
patients
are
referred
to
an
appropriate
clinic
for
further
investigation
and
management.
[The]
reasons
for
this
are
multifarious
and
complex,
reflecting
both
systems
failure
and
patient
choice.
"Unless
these
are
understood
and
addressed,
the
Department
of
Health
Hepatitis
C Strategy
(2002)
and
Action
Plan
for
England
(2004)
will
fail
to
achieve
their
intended
objectives. 04/04/06 Reference
WL
Irving,
S Smith,
R Cater,
and
others.
Clinical
pathways
for
patients
with
newly
diagnosed
hepatitis
C -
What
actually
happens.
Journal
of
Viral
Hepatitis
13
(4):
264-271.
April
2006.
| 
