1*Office of Public Health/Population Health †Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
To examine the effect of provider type on outcomes and safety in a large hepatitis C virus (HCV)-infected cohort treated in routine medical practice.
Nonphysician providers (NPP) are uniquely positioned to expand health care infrastructure to meet HCV treatment demands.
Retrospective, observational cohort analysis of 820 HCV genotype 1-infected veterans initiated on peginterferon/ribavirin and boceprevir or telaprevir in routine medical practice at 94 VA facilities before January 1, 2012 and followed through July 30, 2013. Provider type was determined from prescription records and included physicians (MD) or NPPs (ie, nurse practitioners, physician assistants, and pharmacists). Inverse probability-of-treatment weighting and unweighted logistic regression analysis was used for comparison of sustained virologic response (SVR), treatment discontinuation rates, and adverse hematologic events.
There was no significant difference in SVR by provider type overall (NPPs 51% vs. MDs 47%, P=0.27) and within patient subgroups, or in treatment discontinuation rates. In multivariate analyses, provider type was not associated with any significant difference in the odds of achieving SVR (NPP vs. MD; odds ratio 1.21; 95% confidence interval, 0.87-1.69; P=0.25, inverse probability-of-treatment weighting; odds ratio 1.19; 95% confidence interval, 0.87-1.64; P=0.27, unweighted). Hematologic adverse event rates were similar: anemia: 57% NPP, 62% MD; thrombocytopenia: 43% NPP, 40% MD; neutropenia: 40% NPP, 39% MD.
Treatment prescribed by NPPs was as likely to result in SVR as treatment prescribed by MDs, even after accounting for patient differences. Engaging more NPPs as HCV treatment providers may allow wider access to HCV treatment.