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

Mandel E, Kendall CE, Mason K, Guyton M, Lettner B, Broad J, Altenberg J, Donelle J, Powis. Can Liver J. 2020; 3(2):203-11. Epub 2019 Nov 12. DOI:

Background — 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.

Methods — 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).

Conclusion — 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.

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