Primary Care Providers Knowledge, Attitude and Practices Related to Hepatitis C Screening and Treatment in the Oral Direct Acting Antiviral Agents Era

Abstract

BackgroundThere are over 3 million Americans infected with hepatitis C virus (HCV). Despite recent advances in HCV treatment, a major barrier to care remains a limited number of treaters. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians.ObjectiveTo characterize current HCV care practices, willingness and self-efficacy of PCPs to become HCV treaters.Design, participants and main measuresTwo hundred and seventy one PCPs were identified from community clinics affiliated with a large academic center and 4 large federally qualified health centers in Baltimore, MD. An internet-based survey was administered to assess provider demographics, clinical practice site and willingness to provide HCV care. Factors associated with willingness to provide HCV care were examined using odds ratios (OR).Key resultsAmong 129 (48%) PCPs who responded, the majority (70%) had an MD/DO degree and were white (60%). Only a few PCPs, 12 (10%), had treated at least 1 patient for HCV in the prior year. Although only 22% agreed that HCV treatment should be provided by PCPs, 84% were interested in more HCV training. Willingness to provide treatment was strongly linked to having a high proportion of HCV-infected patients (>20% versus <20%; OR 3.9; 95% confidence interval [CI] 1.5–10) and availability of other services at the primary care site including HIV treatment (OR 6.5; 95% CI 2.5–16.5), substance abuse treatment (OR 3.3; 95% CI 1.3–8.4) and mental health services (OR 4.9; 95% CI 2.0–12.1).ConclusionThese data suggest that efforts to expand HCV medical provider capacity will be most impactful if they initially focus HCV training on PCPs with a high prevalence of HCV among their patients and existing systems to support HCV care.

Treatment Outcomes of Hepatitis C-Infected Patients in Specialty Clinic vs. Primary Care Physician Clinic: A Comparative Analysis

“…HCV treatment is often restricted by payers to patients with advanced fibrosis forcing PCPs to perform additional tests like a fibroscan that requires another complex level of understanding [24, 25]. Time restraints, knowledge gaps, easy access to the specialty referral, apprehension of medicolegal litigation, lack of HCV treatment in PCP quality measures, and provider restrictions on the prescription of independent HCV treatment are some of the reasons why PCPs are not comfortable treating hepatitis C [23, 26, 27]. Definitely, voluntary participation by PCPs is still the key factor here.…”

Room for Improvement: Rates of Birth Cohort Hepatitis C Screening in Primary Care Practices—A WWAMI Region Practice and Research Network Study

“…17 However, primary care providers may lack knowledge about or confidence in providing hepatitis C treatment. 18 Multidisciplinary, team-based approaches for treating hepatitis C in primary care can address provider barriers and increase patient access and improve treatment outcomes. 19 Understanding the elements of effective hepatitis C treatment in primary care and dissemination of effective strategies could provide additional support to primary care practices considering provision of hepatitis C treatment in primary care.…”

Assessment of Knowledge, Attitudes, and Practices Regarding Chronic Hepatitis C Treatment and Its Challenges: A Survey of Internal Medicine Residents in a Community Hospital

“…A study conducted by Falade-Nwulia et al showed that a majority of primary care physicians (PCPs) (89%) referred HCV-infected patients to subspecialty clinics [ 11 ]. Market surveys in the US by Shiffman et al reported that 80% of HCV patients are managed by 20% of gastroenterologists [ 12 ].…”

“…Falade-Nwulia et al reported that the majority of PCPs (77%) were aware of the availability of new oral direct-acting agents, and more than two-thirds of them (67%) had correctly identified HCV genotype as an important part of the HCV treatment decision [ 11 ]. However, a significant proportion of residents were unaware of the available treatments for CHC in the setting of varies comorbidities.…”