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Digestive Diseases and Sciences

, Volume 52, Issue 10, pp 2550–2556 | Cite as

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

  • Susan L. ZickmundEmail author
  • Kyle E. Brown
  • Klaus Bielefeldt
Original Paper

Abstract

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.

Keywords

Hepatitis C Provider Knowledge Attitudes Stigmatization Barriers 

Notes

Acknowledgments

SLZ was supported in part by the Veterans Administration Health Services Research & Development Merit Review Entry Program Career Development Award and also by pilot funds from the VA VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC). KEB was supported by a Merit Review grant from the Veterans Administration.

References

  1. 1.
    Wong JB, McQuillan GM, McHutchison JG, Poynard T (2000) Estimating future hepatitis C morbidity, mortality, and costs in the United States. Am J Public Health 90(10):1562–1569PubMedCrossRefGoogle Scholar
  2. 2.
    Neff GW, O’Brien CB, Nery J, et al. (2004) Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infection. Liver Transpl 10(12):1497–1503PubMedCrossRefGoogle Scholar
  3. 3.
    Chan SE, Rosen HR (2003) Outcome and management of hepatitis C in liver transplant recipients. Clin Infect Dis 37(6):807–812PubMedCrossRefGoogle Scholar
  4. 4.
    Vierling JM, Villamil FG, Rojter SE, Camacho KB, Goldman DE (1997) Morbidity and mortality of recurrent hepatitis C infection after orthotopic liver transplantation. J Viral Hepat 4(Suppl 1):117–124PubMedGoogle Scholar
  5. 5.
    Fraenkel L, McGraw S, Wongcharatrawee S, Garcia-Tsao G (2006) Patients’ experiences related to anti-viral treatment for hepatitis C. Patient Educ Couns 62(1):148–155.Google Scholar
  6. 6.
    Balfour L, Cooper C, Tasca GA, Kane M, Kowal J, Garber G (2004) Evaluation of health care needs and patient satisfaction among hepatitis C patients treated at a hospital-based, viral hepatitis clinic. Can J Public Health 95(4):272–277PubMedGoogle Scholar
  7. 7.
    Schafer A, Scheurlen M, Felten M, Kraus MR (2005) Physician-patient relationship and disclosure behaviour in chronic hepatitis C in a group of German outpatients. Eur J Gastroenterol Hepatol 17(12):1387–1394PubMedCrossRefGoogle Scholar
  8. 8.
    Zickmund S, Hillis SL, Barnett MJ, Ippolito L, LaBrecque DR (2004) Hepatitis C virus-infected patients report communication problems with physicians. Hepatology 39(4):999–1007PubMedCrossRefGoogle Scholar
  9. 9.
    Fontana RJ, Kronfol Z (2004) The patient's perspective in hepatitis C. Hepatology 39(4):903–905PubMedCrossRefGoogle Scholar
  10. 10.
    Hu SW, Lai HR, Liao PH (2004) Comparing dental students’ knowledge of and attitudes toward hepatitis B virus-, hepatitis C virus-, and HIV-infected patients in Taiwan. AIDS Patient Care STDS 18(10):587–593PubMedCrossRefGoogle Scholar
  11. 11.
    van de Mortel TF (2003) Registered and enrolled nurses’ knowledge of hepatitis C and attitudes towards patients with hepatitis C. Contemp Nurse 16(1–2):133–144PubMedGoogle Scholar
  12. 12.
    Takahama AJ, Tatsch F, Tannus G, Lopes MA (2005) Hepatitis C: incidence and knowledge among Brazilian dentists. Commun Dent Health 22(3):184–187Google Scholar
  13. 13.
    Beard JR, Sladden TJ, Dunn TM (1995) Management of hepatitis C in general practice. Med J Aust 163(5):275PubMedGoogle Scholar
  14. 14.
    Everhart JE, Stolar M, Hoofnagle JH (1997) Management of hepatitis C: a national survey of gastroenterologists and hepatologists. Hepatology 26(3; Suppl 1):78S–82SPubMedCrossRefGoogle Scholar
  15. 15.
    Shehab TM, Sonnad SS, Jeffries M, Gunaratnum N, Lok AS (1999) Current practice patterns of primary care physicians in the management of patients with hepatitis C. Hepatology 30(3):794–800PubMedCrossRefGoogle Scholar
  16. 16.
    Nicklin DE, Schultz C, Brensinger CM, Wilson JP (1999) Current care of hepatitis C-positive patients by primary care physicians in an integrated delivery system. J Am Board Fam Pract 12(6):427–435PubMedGoogle Scholar
  17. 17.
    Flowerdew JM, McGrory BJ (2000) Hepatitis C virus infection: knowledge in the orthopedic community. Am J Orthop 29(4):279–281PubMedGoogle Scholar
  18. 18.
    Zdanuk S, Gimpel J, Uhanova J, Kaita KD, Minuk GY (2001) The impact of medical informatics on the confidence of rural physicians caring for patients with chronic hepatitis C viral infections. Fam Pract 18(6):602–604PubMedCrossRefGoogle Scholar
  19. 19.
    Shehab TM, Sonnad SS, Lok AS (2001) Management of hepatitis C patients by primary care physicians in the USA: results of a national survey. J Viral Hepat 8(5):377–383PubMedCrossRefGoogle Scholar
  20. 20.
    Dev A, Sievert W (2002) A survey of Australian general practice management of hepatitis C-infected patients from non-English-speaking backgrounds. J Gastroenterol Hepatol 17(3):295–300PubMedCrossRefGoogle Scholar
  21. 21.
    Bain VG, Wong WW, Greig PD, Yoshida EM (2003) Hepatology and the Canadian gastroenterologist: interest, attitudes and patterns of practice: results of a national survey from the Canadian Association of Gastroenterology. Can J Gastroenterol 17(1):25–29PubMedGoogle Scholar
  22. 22.
    Shehab TM, Sonnad S, Gebremariam A, Schoenfeld P (2002) Knowledge of hepatitis C screening and management by internal medicine residents: trends over 2 years. Am J Gastroenterol 97(5):1216–1222PubMedCrossRefGoogle Scholar
  23. 23.
    Sood A, Midha V, Awasthi G (2002) Hepatitis C—knowledge & practices among the family physicians. Trop Gastroenterol 23(4):198–201PubMedGoogle Scholar
  24. 24.
    Shehab TM, Orrego M, Chunduri R, Lok AS (2003) Identification and management of hepatitis C patients in primary care clinics. Am J Gastroenterol 98(3):639–644PubMedCrossRefGoogle Scholar
  25. 25.
    D’Souza RF, Glynn MJ, Alstead E, Foster GR, Osonayo C (2004) Improving general practitioners’ knowledge of chronic hepatitis C infection. QJM 97(8):549–550PubMedCrossRefGoogle Scholar
  26. 26.
    Peksen Y, Canbaz S, Leblebicioglu H, Sunbul M, Esen S, Sunter AT (2004) Primary care physicians’ approach to diagnosis and treatment of hepatitis B and hepatitis C patients. BMC Gastroenterol 4(1):3PubMedCrossRefGoogle Scholar
  27. 27.
    D’Souza RF, Glynn MJ, Alstead E, Osonayo C, Foster GR (2004) Knowledge of chronic hepatitis C among East London primary care physicians following the Department of Health's educational campaign. QJM 97(6):331–336PubMedCrossRefGoogle Scholar
  28. 28.
    Clark EC, Yawn BP, Galliher JM, Temte JL, Hickner J (2005) Hepatitis C identification and management by family physicians. Fam Med 37(9):644–649PubMedGoogle Scholar
  29. 29.
    Fraser J, Alexander C, Fisher K (2004) Hepatitis C education needs of rural general practitioners working in northern New South Wales. Aust J Rural Health 12(4):152–156PubMedCrossRefGoogle Scholar
  30. 30.
    Cotler SJ, Patil R, McNutt RA, et al. (2001) Patients’ values for health states associated with hepatitis C and physicians’ estimates of those values. Am J Gastroenterol 96(9):2730–2736PubMedCrossRefGoogle Scholar
  31. 31.
    Coppola AG, Karakousis PC, Metz DC, et al. (2004) Hepatitis C knowledge among primary care residents: is our teaching adequate for the times? Am J Gastroenterol 99(9):1720–1725PubMedCrossRefGoogle Scholar
  32. 32.
    Clark EC, Yawn BP, Galliher JM, Temte JL, Hickner J (2005) Hepatitis C identification and management by family physicians. Fam Med 37(9):644–649PubMedGoogle Scholar
  33. 33.
    Fischer LR, Conboy KS, Tope DH, Shewmake DK (2000) Educating health professionals: a hepatitis C educational program in a health maintenance organization. Am J Manag Care 6(9):1029–1036PubMedGoogle Scholar
  34. 34.
    Saeian K, Rochling FA, Burke R, Bragg DS, Franco J (1998) Faculty and trainee knowledge of hepatitis C infection at a tertiary care medical center. WMJ 97(2):43–46PubMedGoogle Scholar
  35. 35.
    Anjum Q, Siddiqui H, Ahmed Y, Rizvi SR, Usman Y (2005) Knowledge of students regarding hepatitis and HIV/AIDS of a private medical university in Karachi. J Pak Med Assoc 55(7):285–288PubMedGoogle Scholar
  36. 36.
    National Institutes of Health (2002) NIH consensus statement on management of hepatitis C: 2002. NIH Consensus & State-of-the-Science Statements 19(3):1–46Google Scholar
  37. 37.
    Patil R, Cotler SJ, Banaad-Omiotek G, et al. (2001) Physicians’ preference values for hepatitis C health states and antiviral therapy: a survey. BMC Gastroenterol 1(1):6PubMedCrossRefGoogle Scholar
  38. 38.
    Kim WR (2002) The burden of hepatitis C in the United States. Hepatology 36(5; Suppl 1):S30–S34PubMedCrossRefGoogle Scholar
  39. 39.
    Lauer GM, Walker BD (2001) Hepatitis C virus infection. N Engl J Med 345(1):41–52PubMedCrossRefGoogle Scholar
  40. 40.
    Banwell C, Bammer G, Gifford SM, O’Brien ML (2005) Australian lesbian and bisexual women's health and social experiences of living with hepatitis C. Health Care Women Int 26(4):340–354PubMedCrossRefGoogle Scholar
  41. 41.
    Crockett B, Gifford SM (2004) “Eyes Wide Shut”: narratives of women living with hepatitis C in Australia. Women Health 39(4):117–137PubMedCrossRefGoogle Scholar
  42. 42.
    Gifford SM, O’Brien ML, Bammer G, Banwell C, Stoove M (2003) Australian women's experiences of living with hepatitis C virus: results from a cross-sectional survey. J Gastroenterol Hepatol 18(7):841–850PubMedCrossRefGoogle Scholar
  43. 43.
    Gifford SM, O’Brien ML, Smith A, et al. (2005) Australian men's experiences of living with hepatitis C virus: results from a cross-sectional survey. J Gastroenterol Hepatol 20(1):79–86PubMedCrossRefGoogle Scholar
  44. 44.
    Hopwood M, Treloar C (2004) Receiving a hepatitis C-positive diagnosis. Intern Med J 34(9–10):526–531PubMedCrossRefGoogle Scholar
  45. 45.
    Zickmund S, Ho EY, Masuda M, Ippolito L, LaBrecque DR (2003) “They treated me like a leper.” Stigmatization and the quality of life of patients with hepatitis C. J Gen Intern Med 18(10):835–844PubMedCrossRefGoogle Scholar
  46. 46.
    Blasiole JA, Shinkunas L, LaBrecque DR, Arnold RM, Zickmund SL (2006) Mental and physical symptoms associated with lower social support for patients with hepatitis C. World J Gastroenterol 12(29):4665–4672PubMedGoogle Scholar
  47. 47.
    Crossley ML (2004) An investigation of dentists’ knowledge, attitudes and practices towards HIV+ and patients with other blood-borne viruses in South Cheshire, UK. Br Dent J 196(12):749–754PubMedCrossRefGoogle Scholar
  48. 48.
    Feldman J, Miner M, Millis M (2004) Training family practice residents in HIV care. AIDS Patient Care STDS 18(7):395–404PubMedCrossRefGoogle Scholar
  49. 49.
    McGinn TG, Gardenier D, McGinn LK, et al. (2005) Treating chronic hepatitis C in the primary care setting. Semin Liver Dis 25(1):65–71PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Susan L. Zickmund
    • 1
    • 4
    Email author
  • Kyle E. Brown
    • 2
  • Klaus Bielefeldt
    • 3
  1. 1.VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Iowa City Veterans Administration Medical Center and Department of Internal MedicineUniversity of Iowa Roy J. and Lucille A. Carver College of MedicineIowa CityUSA
  3. 3.Department of MedicineUniversity of Pittsburgh School of Medicine, Division of Gastroenterology, Hepatology and NutritionPittsburghUSA
  4. 4.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA

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