New research from a team of gastroenterologists finds that people diagnosed with hepatitis C (HCV) are more than twice as likely to avoid their first visit with a gastroenterologist or hepatologist compared to patients referred to those specialists for other reasons.1
No Shows Occur in All Treatment Stages: Study
The study's investigators say they initiated their research to find out what might be impeding successful treatment of patients with chronic hepatitis C infection. They said there's been a growing awareness of these challenges in the past few years, which manifest themselves through each therapy segment, from the initial referral to consultation and patient evaluation, to treatment and follow-up.
The number of HCV patients who failed to keep appointments for an initial consultation was seen firsthand by Joseph Yarze, MD, one of the study's investigators. Yarze is a gastroenterologist at Glens Falls Hospital in New York and also practices at Gastroenterology Associates of Northern New York outside Albany.
Is it Common?
As such, Yarze stated that he decided to conduct this study to determine if this problem actually exists in other gastroenterology practices.
The study focused on patients who had been referred to Yarze between late 2003 and mid-2005. He counted the number of patients who had been given referrals during that period, then compared that to the number of 'no-shows'. From that point, Yarze counted the number of patients referred for a hepatitis C consultation who failed to make their first appointments compared to those who failed to show up for a consultation related to other gastroenterologic or hepatologic reasons.
During those months on which this research focused, there were 543 new patients referred for an initial office consultation, Yarze reported. Of those, 66 were referred for a hepatitis C evaluation. Four hundred seventy-seven, by contrast, were referred for other reasons.
The study found that of those HCV patients referred, more than 18 percent missed their initial appointment. That compares to fewer than 8 percent of those who failed to arrive at the gastroenterology practice for other reasons. Translated, Yarze concluded that people referred to him for an HCV consultation were more than two-and-a-half times more likely to skip out on their appointment compared to those who were referred for another gastroenterologic condition.
Reasons for No Shows Unknown
Yarze said he could not speculate on the reason why more HCV patients decided not to arrive for their consultation more often.
While the reasons for the no-shows in the latest study aren't given, some experts believe the early lack of symptoms and a possible inefficient method of communicating the reason for a referral by the referring physician may be two reasons patients fail to make their appointments with a specialist. Additionally, they say, patients who keep appointments with a gastroenterologist or hepatologist for other reasons may be more motivated to do so because of a strong discomfort or pain due to such conditions as diarrhea, abdominal pain, or swallowing difficulty.
At least one other study has found that missed appointments are key barriers to receiving proper treatment for hepatitis C.2 "Multimodal interventions may be required to increase HCV treatment rates," wrote the study's authors.
1. American College of Gastroenterology 70th Annual Scientific Meeting. 2005 Oct 31-Nov 2. Honolulu, HI.
2. Morrill JA, Shrestha M, Grant RW. Barriers to the treatment of hepatitis C. Patient, provider, and system factors. J Gen Intern Med 2005 Aug;20(8):754-8.
John Martin is a long-time health journalist and an editor for CuraScript. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
