Background: There are an estimated 3.5 million people in the United States living with Hepatitis C virus (HCV); 75-85% of those will develop a chronic infection that can result in liver complications. It is crucial to identify positive infections immediately to ensure linkage to a provider and prevent the advancement of HCV. Initial face-to-face contact in the hospital with a patient can lead to successful outpatient care. The purpose of this retrospective cohort study is to determine if patients who are identified to be positive for HCV will seek medical follow-up care if their initial contact with a patient navigator is face-to-face (in person) or non-face-to-face (over the phone).
Methods: This study was conducted at Jersey City Medical Center (JCMC) where all patients over the age of 18 who are admitted on an inpatient floor are routinely screened for HCV. This was a retrospective cohort study of HCV RNA positive patients who were tested and outreached at JCMC from June 1, 2017 to August 31, 2018. Obtaining HCV antibody (AB) results within 24 hours allowed navigators to make a face-to-face encounter with all eligible patients. Navigators provided HCV streamline education, collected contact information, and scheduled follow-up appointments. Descriptive statistics and Chi-Square was used to analyze the number of patients who attended their scheduled appointments with a provider in order to compare linkage to care rates between face-to-face and non-face-to-face initial encounters. Patients who were already in care, expired, moved, incarcerated, or terminally ill were excluded from the analysis.
Results: JCMC identified 146 patients who required linkage to care. 50 out of 71 (70%) of these patients were successfully linked after a face-to-face encounter with a patient navigator. When the initial contact with the patient was made over the phone or non-face-to-face, 28 out of 75 (37%) attended their first appointment. Our results show a statistically significant difference between initial encounter types and linkage rates. Patients who were initially contacted face-to-face in the hospital were more likely to attend their appointment compared to those patients whose initial encounter was non-face-to-face (x2=16.04; df=1; p=0.000062).
Conclusions: Engaging with a patient face-to-face in an inpatient setting can have an impact on patient’s attendance to their first HCV follow-up appointment. By obtaining patients HCV AB results within 24 hours gives the Navigators a better chance at initiating contact with the patient. Face-to-face initial contact provides Navigators with the opportunity to build rapport with the patient and gather correct contact information for post discharge follow-up. Initial face-to-face contact with the patient while they are still in the hospital will lead to more successful linkage rates.