Identification and Management of Hepatitis C Patients in Primary Care Clinics

Shehab, Thomas M.; Orrego, Mauricio; Chunduri, Renu; Lok, Anna S.

doi:10.1111/j.1572-0241.2003.07331.x

Cited by 69 publications

(57 citation statements)

References 10 publications

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“…However, only 39% of internal medicine residents and less than two-thirds of generalists mentioned that they consistently obtain this information when examining new patients [15,19,22,28]. Using a chart review of newly identified cases, investigators found very few patients were tested for HCV because of physician-identified risk factors [24].…”

Section: Screening and Testingmentioning

confidence: 98%

“…The remaining three articles examined knowledge of and attitudes toward HCV infection in dentists, dental students, or nurses [10][11][12]. In 20 investigations, either the target population was randomly selected or the entire designated population was contacted for participation [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Successful recruitment, defined as at least 75% enrollment, was reported by five of the cross-sectional studies, all but three of which relied on convenience sampling [16,17,26,30,31].…”

Section: Target Groups and Recruitmentmentioning

confidence: 99%

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A Systematic Review of Provider Knowledge of Hepatitis C: Is it Enough for a Complex Disease?

2007

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As studies indicate that patients with hepatitis C face poor provider knowledge and even stigmatization, we conducted a systematic review of provider knowledge about and attitudes toward hepatitis C. We searched Medline for original studies between 1990 and 2005. Articles were abstracted to define target population, recruitment strategies, study design, and key findings. Twenty-six publications performed in nine countries were identified. Whereas studies demonstrated an understanding of the nature of hepatitis C, significant knowledge deficits existed related to natural history, diagnostic approaches, and treatment. The relevance of simple measures, such as vaccinations against hepatitis A and B, was underappreciated. While providers were aware of risk factors for the disease, there were substantial misperceptions, with 5%-20% of providers considering casual contact as a risk for disease acquisition. We conclude that while healthcare providers understand the nature of hepatitis C, important knowledge gaps persist, which may constitute barriers to appropriate therapy.

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Section: Screening and Testingmentioning

confidence: 98%

Section: Target Groups and Recruitmentmentioning

confidence: 99%

A Systematic Review of Provider Knowledge of Hepatitis C: Is it Enough for a Complex Disease?

2007

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“…We also did not assess why more patients in opiate maintenance treatment programs did not receive HCV treatment. Clearly, there is a selection bias, although the same can be said for treatment studies in non-IDU patients [38]. In a previous screening study among Swiss patients on opiate maintenance treatment, the type and distribution of reasons for nonparticipation of hepatitis C seropositive candidates were assessed using a semistructured questionnaire [39].…”

Section: Discussionmentioning

confidence: 99%

Swiss Multicenter Study Evaluating the Efficacy, Feasibility and Safety of Peginterferon-Alfa-2a and Ribavirin in Patients with Chronic Hepatitis C in Official Opiate Substitution Programs

Fried¹,

Monnat

Seidenberg³

et al. 2008

Digestion

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Background: Though patients in opiate substitution programs are commonly infected with HCV, due to safety and efficacy concerns, they are rarely treated with interferon and ribavirin. Methods: In a multicenter study, HCV-infected patients in opiate maintenance treatment programs received 180 μg pegylated interferon-alfa-2a once weekly, plus daily ribavirin for 24 weeks (genotypes 2, 3), or 48 weeks (genotypes 1, 4). Results: Of the 67 patients enrolled, 31 (46%) had HCV genotypes 1 or 4, and 36 (54%) had genotypes 2 or 3. Intent-to-treat analysis showed end-of-treatment virologic response in 75% of patients (81% of genotypes 2 or 3; 65% of genotypes 1 or 4), and a sustained virologic response in 61% of patients (72% of genotypes 2 or 3; 48% of genotypes 1 or 4). Fifteen patients (22%) did not complete the study, in 5 (8%) cases because of severe adverse events. Conclusions: Drug users with chronic HCV infection, regularly attending an opiate maintenance program in which close collaboration between hepatologists/internists and addiction specialists is assured, can be treated effectively and safely with pegylated interferon-alfa-2a and ribavirin. Treatment results are very similar to those in other patient groups, and thus therapy should also be considered for this population.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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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Identification and Management of Hepatitis C Patients in Primary Care Clinics

Abstract: Hepatitis C testing is rarely initiated in primary care clinics based on physician-identified risk factors. Interventions should be developed to optimize early diagnosis of hepatitis C as significant liver disease may be present despite the absence of symptoms.

Cited by 69 publications

References 10 publications

A Systematic Review of Provider Knowledge of Hepatitis C: Is it Enough for a Complex Disease?

A Systematic Review of Provider Knowledge of Hepatitis C: Is it Enough for a Complex Disease?

Swiss Multicenter Study Evaluating the Efficacy, Feasibility and Safety of Peginterferon-Alfa-2a and Ribavirin in Patients with Chronic Hepatitis C in Official Opiate Substitution Programs

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

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