Monitoring of therapy in patients with chronic hepatitis B virus.

Curtis Cooper, MD, FRCPC
European Journal of Gastroenterology & Hepatology

Special Author Introduction

An urban-based clinic in the developed world is characterized by a diversity of clientele. Given this reality, the challenge of delivering health care for hepatitis C infection goes well beyond establishing a diagnosis and treatment evaluation. Expertise in communication, sensitivity to cultural differences in perception and expectation, and awareness of the differing socioeconomic challenges faced by our patients are required. Failure to recognize that a single approach to care is insufficient to meet our patient's needs results in unhappy clients and a diminished likelihood of delivering optimal care. 

Our manuscript focuses on the sizable immigrant population served by our viral hepatitis clinic and the barriers to hepatitis C care delivery that these patients face. Our experience suggests that equitable care can be achieved. However, this is not easily achieved. Expertise in language interpretation, mental health support, substance abuse and social work is often in short supply. Although often an uphill battle, it falls to us as health care advocates to lobby for consistent, universal assess to these services. It is important to make a conscious decision to recognize the linguistic, ethnic and socioeconomic barriers faced by many of our patients and strive to avoid allowing our natural biases to guide diagnostic investigation and therapeutic decisions. 

We were struck by the great heterogeneity of socioeconomic status of our immigrant patients. The educational levels achieved differ greatly as well. This diversity is described in our manuscript. Again, a 'one size fits all' approach will fail many of our patients.

Currently, there is intense debate related to how medical care should be delivered and reimbursed in the developed world. We believe that it is noteworthy that our multidisciplinary clinic within a publicly funded, universally accessible health care system is able to provide a high level of care to a large proportion of our patients despite great diversity. We hope that this description of our experience is helpful in assisting you to fully appreciate the barriers which challenge your patients and your medical team. There are models of care, including our own, which allow for success.

Curtis Cooper, MD, FRCPC
Associate Professor of Medicine
University of Ottawa
The Ottawa Hospital- Division of Infectious Diseases

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