Impact of comprehensive care on health care use among a cohort of marginalized people living with hepatitis C in Toronto, Canada

Published: November 12, 2019
Category: Bibliography
Authors: Bernadette Lettner RN, Claire Kendall MD, Erin Mandel BSc, Jason Altenberg MSW, Jeff Powis MD, Jennifer Broad DN, Jessy Donelle MSc, Kate Mason MHSc, Mary Guyton RN
Countries: Canada, United States
Language: English
Types: Acute care intervention, Care Management, Population Health
Settings: Hospital, PCP


The majority of new hepatitis C (HCV) cases occur among people who inject drugs. In recent years, multidisciplinary models of HCV treatment have emerged that demonstrate successful treatment outcomes for this population, as well as broad positive individual- and system-level impacts. Our objective was to evaluate changes in health care use among a cohort of people living with HCV before and after engagement with one such program.


Program data were uniquely linked to provincial health administrative databases. Rates of emergency department (ED) visits and hospital admissions of clients from 2011 through 2015 (N = 103) were evaluated using linkages with administrative data for the 2 years before and after program initiation. Data were evaluated using negative binomial regression models with a covariance structure to account for within-individual correlations. Results: Of participants, 72.8% were men (mean age 47 years), and 38% experienced high rates of physical and mental health comorbidity (Aggregated Diagnosis Group score ≥10). Female clients had significantly fewer ED visits (M = 5.04 vs 3.12; risk ratio [RR] 0.61; 95% CI 0.44% to 0.86%) 2 years after program initiation. ED visits for infectious diseases and soft tissue injury were significantly lower for the cohort overall (RRs 0.58 0.51; 95% CIs 0.35% to 0.95% and 0.29% to 0.90%, respectively).


Co-locating HCV treatment within comprehensive primary care and harm reduction services appears to have benefits beyond HCV, including a reduction in ED visits among women and a decrease in ED visits for soft tissue infections for all participants.

community-based treatment models, emergency department use, health administrative data, health-care models, hepatitis C, social determinants of health, substance abuse

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