Current practice patterns of primary care physicians in the management of patients with hepatitis C

Shehab, Thomas M.; Sonnad, Seema S.; Jeffries, Mark; Gunaratnum, Naresh; Lok, Anna S.

doi:10.1002/hep.510300328

Cited by 41 publications

(43 citation statements)

References 16 publications

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“…This proportion compares favorably to another nationwide survey, which found that only 1% of primary care providers had treated patients directly for HCV (Shehab et al, 1999), and suggests that substance abuse treatment physicians may be using innovative approaches to integrate HCV antiviral treatment into their practices. Physicians who provided primary medical care or HIV-related care were more likely to directly prescribe antiviral treatment for HCV than those who did not provide either form of primary medical care.…”

Section: Discussionmentioning

confidence: 65%

“…The survey was adapted from an instrument developed by Shehab et al (1999) and included items designed to assess physician, practice, and patient characteristics, and HCV-related practice patterns. The survey was piloted among 10 physicians who worked in drug treatment settings and was modified based on their responses and feedback.…”

Section: Survey Developmentmentioning

confidence: 99%

“…Although primary care providers have been targeted as gatekeepers for HCV-related care, studies have shown that most primary care providers care for a few HCV-infected patients and refer most to subspecialists (Clark, Yawn, Galliher, Temte, & Hickner, 2005;Shehab, Sonnad, Jeffries, Gunaratnum, & Lok, 1999;Shehab, Sonnad, & Lok, 2001). It is unknown whether similar HCV-related practice and referral patterns exist among substance abuse treatment physicians.…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis C management by addiction medicine physicians: Results from a national survey

Litwin

Kunins

Berg

et al. 2007

Journal of Substance Abuse Treatment

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Drug users are disproportionately affected by hepatitis C virus (HCV), yet they face barriers to health care that place them at risk for levels of HCV-related care that are lower than those of nondrug users. Substance abuse treatment physicians may treat more HCV-infected persons than other generalist physicians, yet little is known about how such physicians facilitate HCV-related care. We conducted a nationwide survey of American Society of Addiction Medicine physicians (n = 320) to determine substance abuse physicians' HCV-related management practices and to describe factors associated with these practices. We found that substance abuse treatment physicians promote several elements of HCV-related care, including screening for HCV antibodies, recommending vaccinations against hepatitis A and B, and referring patients to subspecialists for HCV treatment. Substance abuse physicians who also provide primary medical or HIV-related care were most likely to facilitate HCVrelated care. A significant minority of physicians were either providing HCV antiviral treatment or willing to provide HCV antiviral treatment.

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Section: Discussionmentioning

confidence: 65%

Section: Survey Developmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hepatitis C management by addiction medicine physicians: Results from a national survey

Litwin

Kunins

Berg

et al. 2007

Journal of Substance Abuse Treatment

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“…Several studies have suggested that hepatitis C (HBV) manage-ment is suboptimal in primary care settings [1][2][3][4][5] . In fact, only 59% of primary care physicians (PCPs) reported asking patients about HCV risk factors [3] .…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C risk assessment, testing and referral for treatment in urban primary care: Role of race and ethnicity

Trooskin

Navarro

Winn³

et al. 2007

WJG

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Racial differences exist with respect to HCV risk factor ascertainment and testing, (3) Minority patients, positive for HCV, are less likely to be referred for subspecialty care and treatment. Overall, minorities are less likely to be tested for HCV than whites in the presence of a known risk factor. INTRODUCTIONSeveral studies have suggested that hepatitis C (HBV) manage-ment is suboptimal in primary care settings [1][2][3][4][5] . In fact, only 59% of primary care physicians (PCPs) reported asking patients about HCV risk factors [3] . A similar conclusion was made by another study which found that 46% and 62% of physicians reported that they routinely asked patients about a history of blood transfusion and injection drug use, respectively [4] . Shehab reported that HCV testing is rarely initiated in primary care clinics based on physician identified risk factors such as transfusion prior to 1992 or a history of injection drug use [1] . Similar studies among urban primary care practices, comprising patients at highest risk for exposure to HCV risk factors, have not been reported. Such a study would be important to better assess the feasibility of implementing wide scale risk assessment, testing, and treatment strategies.The purpose of this retrospective cohort study is to assess the rates of HCV risk factor ascertainment, testing and referral for treatment in urban primary care practices, with particular attention to the effect of race and ethnicity as determined by systematic review of the medical records. Abstract AIM: To determine rates of hepatitis C (HCV) risk factor ascertainment, testing, and referral in urban primary care practices, with particular attention to the effect of race and ethnicity. MATERIALS AND METHODS METHODS:Retrospective chart review from four primary care sites in Philadelphia; two academic primary care practices and two community clinics was performed. Demographics, HCV risk factors, and other risk exposure information were collected. RESULTS:Four thousand four hundred and seven charts were reviewed. Providers documented histories of injection drug use (IDU) and transfusion for less than 20% and 5% of patients, respectively. Only 55% of patients who admitted IDU were tested for HCV. Overall, minorities were more likely to have information regarding a risk factor documented than their white counterparts (79% vs 68%, P < 0.0001). Hispanics were less likely to have a risk factor history documented, compared to blacks and whites (P < 0.0001). Overall, minorities were less likely to be tested for HCV than whites in the presence of a known risk factor (23% vs 35%, P = 0.004). Among patients without documentation of risk factors, blacks and Hispanics were more likely to be tested than whites (20% and 24%, vs 13%, P < 0.005, respectively). CONCLUSION:(1) Documentation of an HCV risk factor history in urban primary care is uncommon, (2)

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“…A crosssectional survey of patients attending general practice in the Eastern region of Ireland reported HCV testing rates of 34% and a HCV prevalence rate among those tested of 73% [26]. This low rate of screening for HCV in primary care has also been reported in other healthcare systems [27,28].…”

mentioning

confidence: 91%

Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study (Preprint)

Murtagh¹,

Swan²,

O’Connor³

et al. 2018

Preprint

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Current practice patterns of primary care physicians in the management of patients with hepatitis C

Cited by 41 publications

References 16 publications

Hepatitis C management by addiction medicine physicians: Results from a national survey

Hepatitis C management by addiction medicine physicians: Results from a national survey

Hepatitis C risk assessment, testing and referral for treatment in urban primary care: Role of race and ethnicity

Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study (Preprint)

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