Digestive Diseases and Sciences

, Volume 61, Issue 12, pp 3460–3468 | Cite as

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

  • Mary Thomson
  • Monica A. Konerman
  • Hetal Choxi
  • Anna S. F. Lok
Original Article

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.

Keywords

Hepatitis C General practice Screening Guidelines 

References

  1. 1.
    Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. 2014;160:293–300.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ly KN, Xing J, Klevens RM, et al. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med. 2012;165:271–278.CrossRefGoogle Scholar
  3. 3.
    Freeman RB, Steffick DE, Guidinger MK, et al. Liver and intestine transplantation in the United States, 1997–2006. Am J Transpl. 2008;8:958–976.CrossRefGoogle Scholar
  4. 4.
    McHutchison JG, Bacon BR. Chronic hepatitis C: an age wave of disease burden. Am J Manag Care. 2005;11:S286–S295.PubMedGoogle Scholar
  5. 5.
    Moyer VA. Screening for hepatitis C virus infection in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159:349–357.CrossRefPubMedGoogle Scholar
  6. 6.
    Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep.. 2012;16:1–32.Google Scholar
  7. 7.
    Adebajo CO, Aronsohn A, Te HS, et al. Birth cohort HCV screening is lower in the Emergency Department than the outpatient setting [abstract]. Abstract no. 1066, Digestive Disease Week, May 16–19, 2015, Washington, DC.Google Scholar
  8. 8.
    Litwin AH, Smith BD, Drainoni M, et al. Primary care-based interventions are associated with increases in hepatitis C virus testing for patients at risk. Dig Liver Dis. 2012;44:497–503.CrossRefPubMedGoogle Scholar
  9. 9.
    Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. N Engl J Med. 2013;368:1859–1861.CrossRefPubMedGoogle Scholar
  10. 10.
    Afdhal N, Zuesem S, Kwo P, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med. 2014;370:1889–1898.CrossRefPubMedGoogle Scholar
  11. 11.
    Ferenci P, Bernstein D, Lalezari J, et al. ABT-450/r-ombitasvir and dasabuvir with or without ribavirin for HCV. N Engl J Med. 2014;370:1983–1992.CrossRefPubMedGoogle Scholar
  12. 12.
    Feld JJ, Kowdley KV, Coakley E, et al. Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med. 2014;370:1594–1603.CrossRefPubMedGoogle Scholar
  13. 13.
    Ghany MGND, Strader DB, Thomas DL, Seeff LB. An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54:1433–1444.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Asrani SK, Davis GL. Impact of birth cohort screening for hepatitis C. Curr Gastroenterol Rep. 2014;16:381–387.CrossRefPubMedGoogle Scholar
  15. 15.
    Clark EC, Yawn BP, Galliher JM, Temte JL, Hickner J. Hepatitis C identification and management by family physicians. Fam Med. 2005;37:644–649.PubMedGoogle Scholar
  16. 16.
    Shehab TM, Sonnad SS, Lok ASF. Management of hepatitis C patients by primary care physicians in the USA: results of a national survey. J Viral Hepat. 2001;8:377–383.CrossRefPubMedGoogle Scholar
  17. 17.
    Yehia BR, Schranz AJ, Umsccheid CA, Lo Re V. The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis. PLoS ONE. 2014;9:e101554.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364:2199–2207.CrossRefPubMedGoogle Scholar
  19. 19.
    Cunningham CT, Quan H, Hemmelgarn B, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015;9:32.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mary Thomson
    • 1
  • Monica A. Konerman
    • 2
  • Hetal Choxi
    • 3
  • Anna S. F. Lok
    • 2
  1. 1.Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Division of Gastroenterology, Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Department of Family MedicineUniversity of Michigan Health SystemAnn ArborUSA

Personalised recommendations