Hepatitis C Notification Time Frames Vary

There is considerable variation among VA facilities in the time it takes to  notify veterans that they have hepatitis C. Systemwide, 71 facilities, in  response to our survey, estimated typical notification time frames of 30  days or less, including 29 facilities with estimates of 7 days or less. In  contrast, 30 facilities estimated that notification typically took longer than  30 days, including 7 facilities that estimated time frames of 90 days or  longer. Facilities estimating longer notification times (over 30 days) generally  relied on primary care providers to notify veterans at their next regularly  scheduled appointments, often more than 30 days away and, in some  cases, longer than 4 months away. In the meantime,  however, veterans with hepatitis C could 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. For example, providers at 4 facilities scheduled  special appointments to discuss hepatitis C test results with veterans, and  providers at 17 facilities notified veterans by telephone or mail. This system proactively reminds primary care  providers to notify veterans. Evaluations of Medical Conditions of Veterans with Hepatitis C Hampered by Waits for Physician Specialist Appointments

Almost all VA medical facilities involved physician specialists in  evaluating veterans with hepatitis C to determine a treatment  recommendation, but waiting times for appointments with physician  specialists varied considerably. Recommendations for Executive Action

To continue to improve the management of hepatitis C, we recommend  that the Secretary of Veterans Affairs direct the Under Secretary for Health  to    direct facilities to use special arrangements, such as mail or telephone  when appropriate, to notify a veteran rather than waiting until the next  regularly scheduled visit if it is more than 30 days away;    direct facilities to modify their computerized patient record systems so  that providers are alerted to positive hepatitis C test results as soon as  possible; and    help facilities improve the timeliness of evaluations for veterans diagnosed  with hepatitis C by encouraging facilities to use nonspecialists to conduct  initial evaluations, and develop clinical guidelines for when to refer  veterans to physician specialists for additional consultations. We also reviewed and analyzed the current literature  pertaining to hepatitis C.
We conducted an E-mail survey to obtain information on hepatitis C  notification and disease management processes and practices throughout  the VA system, including evaluating veterans’ medical conditions regarding  potential treatment options.
Why GAO Did This Study

In 1998, the Department of Veterans Affairs (VA) launched an initiative to screen and test veterans for hepatitis C--a chronic blood-borne virus that can cause potentially fatal liver-related conditions. Since 2001, GAO has been monitoring VA's hepatitis C program. This year GAO was asked to report on VA's hepatitis C disease management practices. GAO surveyed 141 VA medical facilities about their processes for notifying veterans concerning hepatitis C test results and evaluating veterans' medical conditions regarding potential treatment options. In addition, GAO reviewed medical records of 100 hepatitis C patients at 1 facility and visited 4 other facilities that used unique hepatitis C disease management processes.

What GAO Found

There is considerable variation among VA facilities in the time it takes to notify veterans that they have hepatitis C. For example, 29 VA medical facilities estimated that veterans were typically notified within 7 days of testing 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--sometimes more than 4 months away. In contrast, facilities with shorter notification times 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. VA medical facilities also varied considerably in the time that veterans must wait before physician specialists evaluate their medical conditions concerning hepatitis C treatment recommendations. For example, 23 facilities estimated that veterans waited 30 days or less for appointments with physician specialists while 52 facilities estimated that veterans waited over 60 days. At facilities with longer waiting times, primary care providers frequently referred all veterans to physician specialists for evaluations. In contrast, facilities with shorter waiting times often relied on nonspecialists, such as primary care providers, to conduct initial hepatitis C evaluations, referring only those with certain conditions, such as liver injury, to specialists for additional evaluations.