Primary Care Physician Perspectives on Hepatitis C Management in the Era of Direct-Acting Antiviral Therapy

Abstract

Background Primary care physicians (PCPs) play a critical role in the care cascade for patients with chronic hepatitis C (CHC). Aim To assess PCP knowledge and perspectives on CHC screening, diagnosis, referral, and treatment. Methods An anonymous survey was distributed to PCPs who participated in routine outpatient care at our hospital. Results Eighty (36 %) eligible PCPs completed the survey. More than half were females (60 %) aged 36–50 (55 %) from family (44 %) or internal (49 %) medicine. Overall, PCPs correctly identified high-risk populations for screening, though 19 % failed to identify baby boomers and 45 % failed to identify hemodialysis patients as populations to screen. Approximately half reported they were able to screen at risk patients<50 % of the time secondary to time constraints and difficulty assessing if patients had already been screened. 71 % of PCPs reported they refer all newly diagnosed patients to specialty care. 70 % of PCPs did not feel up to date with current treatment. The majority grossly underestimated efficacy, tolerability and ease of administration, and overestimated treatment duration. Only 9 % felt comfortable treating CHC, even those without cirrhosis. Practice patterns were influenced by specialty and Veterans Affairs Hospital affiliation. Conclusions Although the majority of PCPs are up to date with CHC screening recommendations, few are able to routinely screen in practice. Most PCPs are not up to date with treatment and do not feel comfortable treating CHC. Interventions to overcome screening barriers and expand treatment into primary care settings are needed to maximize access to and use of curative therapies.

A Hepatitis C Educational Needs Assessment of Canadian Healthcare Providers

“…Specialists were the most comfortable with recommending and initiating treatment for CHC, while PCPs were particularly uncomfortable with those roles. This finding is consistent with other studies on PCP knowledge of new DAAs and comfort level with treatment [6]. The finding highlights the need to educate PCPs with novel and longitudinal educational models if PCPs are to become a source of increased capacity for care in the future.…”

High efficacy of Sofosbuvir plus Simeprevir in a large cohort of Spanish cirrhotic patients infected with genotypes 1 and 4

“…We did not find a difference in efficacy between GT1a and GT1b patients, but this may be explained by the wide use of RBV. A third issue regarding the high efficacy of SOF/SMV in our population is the fact that patients were treated by hepatologists in referral centres rather than in community‐based practice; this may result in greater treatment adherence, better management of AE and, secondarily, in higher response rates …”

Hepatitis C: Who should treat hepatitis C virus? The role of the primary care provider

“…Thomson et al reported the results of one survey showing that although PCPs identified high‐risk populations for screening, 19% failed to identify age (“Baby Boomer screening”) and dialysis as risk factors. The PCPs surveyed also did not feel up to date with current treatment, and the majority also underestimated efficacy and tolerability, and overestimated treatment duration . Awareness and educational programs for PCPs will be instrumental in implementing and expanding their role.…”

“…It is essential, therefore, to expand the number of health care providers who can treat hepatitis C and expand treatment to more challenging populations. Thomson et al 3 reported the results of one survey showing that although PCPs identified high-risk populations for screening, 19% failed to identify age (''Baby Boomer screening'') and dialysis as risk factors. The PCPs surveyed also did not feel up to date with current treatment, and the majority also underestimated efficacy and tolerability, Abbreviations: DAA, direct-acting antiviral; ECHO, Extension for the Community Healthcare Outcomes; HCV, hepatitis C virus; NP, nurse practitioner; PCP, primary care provider; SVR, sustained virological response.…”

“…The American Association for the Study of Liver Diseases and the Infectious Disease Society of America should partner with primary care providers (PCPs) to build capacity to treat in primary care and referral systems for medically complex patients. 3. The criminal justice system should screen and treat hepatitis C in correctional facilities according to the national clinical practice guidelines.…”