General practitioners’ perceptions of the provision of direct-acting antivirals for hepatitis C within Australian private general practice: an exploratory qualitative study
Jane Scarborough![https://orcid.org/0000-0002-4094-8707](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-6373-5720](/media/client/orcid_16x16.png)
A College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia.
B Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA 5000, Australia.
C Stretton Institute, The University of Adelaide, North Terrace Campus, Adelaide, SA 5005, Australia.
Australian Journal of Primary Health - https://doi.org/10.1071/PY22271
Submitted: 10 December 2022 Accepted: 11 May 2023 Published online: 5 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: There is a need to increase the involvement of Australian general practitioners (GPs) working in private practice to realise the potential of direct-acting antiviral (DAA) treatments for people with the hepatitis C virus.
Methods: Semi-structured interviews were conducted in 2018 with seven GPs and two practice nurses working in private general practice to elicit the experiences and perceptions of their involvement in providing care for patients with hepatitis C virus in this setting. The interviews were recorded, transcribed and thematically analysed to inform interventions to maximise the provision of DAA in private general practice.
Results: Participants described individual GPs purposely limiting their scope of clinical practice (SOCP) and expressed an expectation that DAA provision would not be included in all GP’s SOCP. When GPs delineate their SOCP, their confidence to competently provide quality health care to their patients and GPs’ professional special interests are important considerations.
Conclusion: Providing DAA training, skill development, support and resources to GPs is necessary, but may not ensure that individual private GPs will provide this care. Where GPs do not include DAA in their SOCP, care pathways need to be developed for patients who will benefit from DAA, including GP-to-GP referral. These findings may be applicable to other areas of unmet need that rely on GPs including provision of care in their SOCP.
Keywords: delivery of health care, disease management, health manpower, health services: accessibility, health services: needs and demands, primary health care, scope of practice - clinical.
References
Australasian Society for HIV Medicine (2018) ASHM annual report 2017–2018. Available at https://nla.gov.au/nla.obj-1962874767/view. [Accessed 12 November 2022]Australian College of Rural and Remote Medicine (2022) Drug and alcohol addiction education program. Available at https://www.acrrm.org.au/courses/online/drug-alcohol. [Accessed 12 November 2022]
Bell SFE, Harvey C, Mack F, Lambert S, Lazarou M, Strom K, Dean JA (2022) Rethinking referral pathways: qualitative evaluation of general practice networks to increase access to intrauterine contraception. Family Practice 39, 1109–1115.
| Rethinking referral pathways: qualitative evaluation of general practice networks to increase access to intrauterine contraception.Crossref | GoogleScholarGoogle Scholar |
Braun V, Clarke V, Hayfield N, Terry G (2019) Thematic analysis. In ‘Handbook of research methods in health social sciences’. (Ed. P Liamputtong) pp. 843–860. (Springer)
Burnet Institute and Kirby Institute (2022) Australia’s progress towards hepatitis C elimination annual report 2022. Available at https://burnet.edu.au/media/1trbt5iy/australias-progress-towards-hepatitis-c-elimination-annual-report-2022-anna-wilkinson.pdf [Accessed 25 May 2023]
Clark PJ (2021) Eliminating hepatitis C in Australia needs informed patients and enabled GPs. The Medical Journal of Australia 215, 318–319.
| Eliminating hepatitis C in Australia needs informed patients and enabled GPs.Crossref | GoogleScholarGoogle Scholar |
Gastroenterological Society of Australia (2020) Remote consultation request for initiation of hepatitis C treatment. Available at https://www.gesa.org.au/public/13/files/Education%20%26%20Resources/Clinical%20Practice%20Resources/Hep%20C/Remote%20consultation%20form%202022.pdf [Accessed 25 May 2023]
Gooey M, Wong E, Pedrana A, Allard N, Doyle J, Hellard M, Wade A (2020) A survey of Australian general practitioners’ hepatitis C knowledge and management 2 years after subsidised direct-acting antiviral therapy became available. Sexual Health 17, 387–389.
| A survey of Australian general practitioners’ hepatitis C knowledge and management 2 years after subsidised direct-acting antiviral therapy became available.Crossref | GoogleScholarGoogle Scholar |
Government of South Australia – SA Health (2017) Nursing model of care for viral hepatitis management in South Australia. Available at https://www.sahealth.sa.gov.au/wps/wcm/connect/f5dc9e63-ad02-4d51-801c-164efc46143d/NursingMOCViralHepatitisManagementSA-CDCB-04122017.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-f5dc9e63-ad02-4d51-801c-164efc46143d-mMH6i7M [Accessed 12 November 2022]
Haridy J, Iyngkaran G, Nicoll A, Muller K, Wilson M, Wigg A, Ramachandran J, Nelson R, Bloom S, Sasadeusz J, Watkinson S, Colman A, Altus R, Tilley E, Stewart J, Hebbard G, Liew D, Tse E (2021) Outcomes of community-based hepatitis C treatment by general practitioners and nurses in Australia through remote specialist consultation. Internal Medicine Journal 51, 1927–1934.
| Outcomes of community-based hepatitis C treatment by general practitioners and nurses in Australia through remote specialist consultation.Crossref | GoogleScholarGoogle Scholar |
Heard E, Massi L, Smirnov A, Selvey LA (2020) Prescribing direct-acting antivirals to treat hepatitis C virus in a general practice setting in Australia: ‘So why not do it’? Internal Medicine Journal 50, 1053–1058.
| Prescribing direct-acting antivirals to treat hepatitis C virus in a general practice setting in Australia: ‘So why not do it’?Crossref | GoogleScholarGoogle Scholar |
Hepatitis Australia (2022) A cure for hepatitis C. Available at https://www.hepatitisaustralia.com/hepatitis-c-cures#:~:text=The%20following%20DAA%20medicines%20are,Harvoni%C2%AE%20(sofosbuvir%20%2B%20ledipasvir) [Accessed 12 November 2022]
Hepatitis C Virus Infection Consensus Statement Working Group (2020) Australian recommendations for the management of hepatitis C virus infection: a consensus statement (June 2020). Available at https://ashm.blob.core.windows.net/ashmpublic/hepatitis-C-virus-infection-a-consensus-statement-Jun-2020.pdf [Accessed 12 November 2022]
Hopwood M, Treloar C (2013) Under the watchful eye of ‘a benevolent dictator’ – general practitioner and patient experiences of hepatitis C treatment initiation and shared-care in general practice. Australian Family Physician 42, 900–903.
Kwon JA, Dore GJ, Hajarizadeh B, Alavi M, Valerio H, Grebely J, Guy R, Gray RT (2021) Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications. PLoS ONE 16, e0257369
| Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications.Crossref | GoogleScholarGoogle Scholar |
Ley S (2016) Hep C cures available today for as low as $6.20 a prescription – media release. Available at https://parlinfo.aph.gov.au/parlInfo/download/media/pressrel/4401630/upload_binary/4401630.pdf;fileType=application%2Fpdf#search=%22media/pressrel/4401630%22 [Accessed 12 November 2022]
MacLachlan JH, Stewart S, Cowie BC (2021) Viral hepatitis mapping project: national report 2020. Available at https://ashm.org.au/wp-content/uploads/2022/04/ASHM_ViralHepReport_2020_WEB_final.pdf [Accessed 12 November 2022]
Medical Board of Australia (2016) Registration standard: continuing professional development. Available at http://www.medicalboard.gov.au/documents/default.aspx?record=WD16%2f19473&dbid=AP&chksum=r3KA%2fZ0ECm3jZ1M7CfEMSw%3d%3d [Accessed 12 November 2022]
QSR International Pty Ltd. (2019) NVivo 10 for Windows. Available at http://www.qsrinternational.com/nvivo/support-overview/downloads/nvivo-10-for-windows [Accessed 13 September 2019]
Royal Australian College of General Practitioners (2020) Handbook for general practitioners – CPD Program requirements for the 2020–22 triennium. Available at https://www.racgp.org.au/FSDEDEV/media/documents/Education/Professional%20development/QI-CPD/GP-Handbook-2020-22-triennium.pdf [Accessed 25 May 2023]
Royal Australian College of General Practitioners (2022) General practice: health of the nation 2022. Available at https://www.racgp.org.au/getmedia/80c8bdc9-8886-4055-8a8d-ea793b088e5a/Health-of-the-Nation.pdf.aspx. [Accessed 3 November 2022]
Scarborough J, Miller ER, Aylward P, Eliott J (2017) ‘Sussing that doctor out.’ Experiences and perspectives of people affected by hepatitis C regarding engagement with private general practitioners in South Australia: a qualitative study. BMC Family Practice 18, 97
| ‘Sussing that doctor out.’ Experiences and perspectives of people affected by hepatitis C regarding engagement with private general practitioners in South Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
The Kirby Institute (2017) HIV, viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2017. Available at https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_Annual-Surveillance-Report-2017_compressed.pdf [Accessed 12 November 2022]
Tran B, Straka P, Falster MO, Douglas KA, Britz T, Jorm LR (2018) Overcoming the data drought: exploring general practice in Australia by network analysis of big data. The Medical Journal of Australia 209, 68–73.
| Overcoming the data drought: exploring general practice in Australia by network analysis of big data.Crossref | GoogleScholarGoogle Scholar |
Wade A, Draper B, Doyle J, Allard N, Grinzi P, Thompson A, Hellard M (2017) A survey of hepatitis C management by Victorian GPs after PBS-listing of direct-acting antiviral therapy. Australian Family Physician 46, 235–240.
Wade AJ, McCormack A, Roder C, McDonald K, Davies M, Scott N, Wardrop M, Athan E, Hellard ME (2018) Aiming for elimination: outcomes of a consultation pathway supporting regional general practitioners to prescribe direct-acting antiviral therapy for hepatitis C. Journal of Viral Hepatitis 25, 1089–1098.
| Aiming for elimination: outcomes of a consultation pathway supporting regional general practitioners to prescribe direct-acting antiviral therapy for hepatitis C.Crossref | GoogleScholarGoogle Scholar |
Wilson H, Schulz M, Rodgers C, Lintzeris N, Hall JJ, Harris-Roxas B (2022) What do general practitioners want from specialist alcohol and other drug services? A qualitative study of New South Wales metropolitan general practitioners. Drug and Alcohol Review 41, 1152–1160.
| What do general practitioners want from specialist alcohol and other drug services? A qualitative study of New South Wales metropolitan general practitioners.Crossref | GoogleScholarGoogle Scholar |
Wright M, Versteeg R (2021) Introducing general practice enrolment in Australia: the devil is in the detail. The Medical Journal of Australia 214, 400–402.e1.
| Introducing general practice enrolment in Australia: the devil is in the detail.Crossref | GoogleScholarGoogle Scholar |