Predictors of Loss to Follow-Up in Patients with Hepatitis C

Abstract

Background. Advancements in hepatitis C virus (HCV) treatment include rapidly changing medical management and shifting criteria for reimbursement of HCV antiviral treatment. These lead to unique challenges in maintaining patient follow up. Methods. Retrospective chart review was used to identify risks factors for loss to patient follow up (LTFU). Patients with ambulatory visits for HCV care between March 2013 and March 2016 in an Infectious Disease academic medical care center (AMC) were identified by ICD 9-10 codes. Patients were defined as LTFU if they had (1) no follow-up appointment scheduled nor kept an appointment within the prior 6 months and (2) had not been discharged nor reassigned to another provider. Logistic regression was used to assess the association between LTFU and variables related to demographics, health behavior and utilization. Results. Two hundred fifty-six patients were identified and 58 (23%) were LTFU. Comparing patients LTFU versus non-LTFU, patients LTFU were younger (49 versus 53), less likely to have Liver Center engagement (2 versus 31%), more likely to have mild (26 versus 16%) or undocumented (22 versus 4%) liver fibrosis, and less likely to have achieved cure (19 versus 62%). Patients LTFU were more likely to live either 0-9 miles or >=35 miles from the AMC and were more likely to have cancelled or missed their last appointment. Variables identified via univariate logistic regression (p < 0.001) and were more likely to have an undocumented liver fibrosis stage (p = 0.02). Compared to patients who lived 0-9 miles from the AMC, patients 10-34 miles and 35-84 miles away were less likely to become LTFU, while those >=85 miles away were more likely to become LTFU (p = 0.03). Conclusion. Miles from AMC, lack of HCV treatment and documentation of liver fibrosis stage are significant predictors of LTFU in patients engaged in HCV care. Findings are important in characterizing barriers to retention in HCV care and informing interventions to reduce LTFU.