HEPATITIS C

From: Doc Melson - docmelson@docmelson.com
To: ~DocsVeteransNews@docmelson. com
Sent: Monday, March 10, 2003 2:31 PM
Subject: VA Health Care: Improvements Needed in Hepatitis C Disease- Issued By GAO

The GAO issued: "VA Health Care: Improvements Needed in Hepatitis C Disease
Management Practices." (1/31/2003 GAO-03-136)
see full report at http://www.gao.gov/new.items/d03136.pdf
Evaluations of Medical Conditions of Veterans with Hepatitis C Hampered by Waits for Physician Specialist Appointments page 10 Conclusions page 13

******** excerpts There is considerable variation among VA facilities in the time it takes to notify veterans that they have hepatitis C. For example, in response to our survey, 29 facilities estimated that veterans are typically notified within 7 days after test results are available, while 16 estimated that notification times exceeded 60 days. At facilities with longer notification times, primary care providers generally notified veterans at their next regularly scheduled appointments, which, in some cases, were more than 4 months away. In contrast, at most facilities with shorter notification times, providers generally scheduled special appointments focused on hepatitis C notification, or notified veterans by telephone or mail. Longer notification times increase the risk that veterans may unknowingly infect others or continue to engage in behaviors, such as alcohol use, that could accelerate the damaging effects of hepatitis C on their livers. There is also considerable variation among VA facilities in the time that veterans must wait before physician specialists evaluate their medical condition concerning hepatitis C treatment recommendations. For example, in response to our survey, 23 facilities estimated that veterans waited 30 days or less while 52 facilities estimated that veterans waited over 60 days, including 26 that had waits exceeding 90 days. At facilities with longer waiting times, primary care providers frequently referred all veterans to physician specialists for evaluations. In contrast, facilities with shorter times (30 days or less) usually relied on nonspecialists to evaluate patients. In these cases, primary care physicians, nurses, or nurse practitioners evaluated veterans and referred only selected veterans, such Results in Brief VA noted that the optimal process will vary depending on local workload, resources, and environment. VA describes these methods in the Under Secretary for Health's Information Letter (mentioned in VA's letter as enclosure 2), which is available on the Web at www.va.gov/publ/direc/health/infolet/10200219.pdf

*********** VA has invested considerably in its efforts to identify and treat veterans with hepatitis C. However, there is wide variation across VA in the time it takes to notify and recommend a course of action for veterans with hepatitis C. When veterans are not promptly notified that they have hepatitis C, they could unknowingly spread the disease to others or engage in activities, such as alcohol use, that could worsen the effect of hepatitis C on their livers. In addition, many veterans must wait too long for their disease to be evaluated by physician specialists. VA can look to successes within its own system to improve processes and timeliness outcomes systemwide. Promoting best practices for notifying veterans about their hepatitis C test results would encourage providers to think of alternate ways of notifying veterans-such as by telephone or mail-when a veteran's next scheduled appointment is more than 30 days away. Other best practices such as the use of a computerized alert reminding providers to notify veterans would further improve VA's hepatitis C program. Likewise, using clinical guidelines to help providers other than physician specialists evaluate certain veterans with hepatitis C would shorten the time that veterans wait to learn what may be the best course of treatment for their disease. In addition, using providers other than physician specialists could help better allocate the expertise of physician specialists across VA locations. Systemwide use of such best practices that are already being used successfully at some VA facilities would benefit all veterans.