地域医療と健康教育

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Evaluating the Impact of a Community Health Worker on Hepatitis C Care in an Urban Emergency Department

Sean Manogue, Zackiya Grant, Shanade Wells, Sarah Sulkowski, Risha Irvin, Giorgio Galetto and Nathan Irvin

Background: Hepatitis C virus (HCV) remains a significant source of liver-related morbidity and mortality in the US and many are unaware of their infection. Emergency departments (ED) represent a valuable resource to improve the HCV care continuum by offering HCV testing and linkage to care. Community health workers have been utilized in diverse healthcare settings to promote engagement of patients in care. We postulated that the addition of a community health worker (CHW) to an urban ED HCV initiative would improve patient care outcomes. Methods: A cross-sectional retrospective study was conducted from May 1st, 2016 to July 30th, 2018 among 780 HCV antibody positive ED patients. HCV linkage to care (LTC) and confirmatory RNA test status were recorded for one calendar year before and after the CHW was introduced on May 1st, 2017. Summary statistics followed by Pearson Chi-square analyses were conducted to understand the impact of the CHW on linkage and confirmation of RNA status. Multivariate logistic regression was then conducted to identify factors associated with RNA testing and linkage to care. Results: In the ED testing program, 780 patients tested HCV Ab positive between 5/1/2016 and 5/1/2018. The mean age was 47.8 ± 13.3, 65.4% were male, 67.8% identified as white, and 28.5% identified as Black. RNA testing rates increased from 33.6% to 49.5% after the CHW was integrated (X2 (2, N=780) = 20.22, p<.01). Linkage to care rates among confirmed HCV RNA positive patients increased from 19.4% to 33.9% after the CHW was integrated (X2 (2, N=196) = 4.6, p<.05). Self-identified Hispanic patients were more likely to be linked (OR=8.7, p<.05), while previously identified HCV positive and cirrhotic patients were more likely to receive RNA testing (OR=1.5, p<.05; OR=2.2, p<.05). Conclusions: The integration of a community health worker into the ED HCV program was associated with significant increases in follow-up testing and linkage to care for HCV. The community health worker incorporated a comprehensive approach to patient healthcare, suggesting that this approach is more successful when engaging ED patients who may represent vulnerable populations.