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Identifying barriers to treatment of HCV in the primary care setting

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Abstract

Objective

To identify practice, attitudes, and potential barriers to treatment of Hepatitis C to primary care practitioners.

Design

A postal survey of general practitioners in New Zealand.

Setting

Nationwide postal survey to all general practitioners in New Zealand.

Participants

All general practitioners in New Zealand identified by their association with Primary Health Organizations.

Main outcomes

Identification barriers to treatment of Hepatitis C amenable to intervention by general practitioners in New Zealand.

Results

3817 general practitioners surveyed. 925 (24.2%) surveys returned. 187 (21%) currently prescribe Hepatitis C medications. 620 (70%) indicated that no general practitioner in their practice had interest in managing Hepatitis C therapy. Hepatitis C training was associated with increased prescribing activity—29% in those with training versus 10% in those without training. Confidence levels in initiating or continuing Hepatitis C therapy significantly rose from 23.8 and 47.8 to 50.2 and 67.7, respectively, with training. Inadequate reimbursement (44%), too few Hepatitis C patients (40%), and caseload with other patients (40%) were the most frequently identified barriers to treatment. Difficulty in obtaining transient elastography (35%) prior to treatment, lack of training (32%), and the perception that Hepatitis C therapy should be done by a specialist (30%) were also frequently reported barriers. General practitioners consistently underestimated the prevalence of Hepatitis C in their practice by a factor of 4.3 to 13.6 (based on an estimated prevalence of 1.9%).

Conclusion

Although the most frequently cited barrier to general practitioner treatment of HCV was reimbursement, this is entwined with other purported barriers such as complexity of the patients, time commitment, caseload, and need for expertise. A lack of awareness of the prevalence of Hepatitis C in the general population is an important barrier. A comprehensive strategy to address multiple barriers, improve treatment regimens, and increase awareness of HCV is needed for ultimate success in the eradication of HCV in New Zealand and worldwide.

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Authors and Affiliations

  1. Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, 9054, New Zealand

    Steve Johnson, Kristina Aluzaite, Anna Taar & Michael Schultz

  2. Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand

    Steve Johnson & Michael Schultz

Authors
  1. Steve Johnson
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  2. Kristina Aluzaite
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  3. Anna Taar
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  4. Michael Schultz
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Correspondence to Steve Johnson.

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Conflict of interest

Steve Johnson, Kristina Aluzaite, Anna Taar, and Michael Schultz declare that they have no conflict of interest.

Ethical statement

Ethical approval was obtained from the University of Otago Human Ethics Committee (reference number D16/400).

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Johnson, S., Aluzaite, K., Taar, A. et al. Identifying barriers to treatment of HCV in the primary care setting. Hepatol Int 13, 58–65 (2019). https://doi.org/10.1007/s12072-018-9902-x

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  • DOI: https://doi.org/10.1007/s12072-018-9902-x

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