General practitioner attitudes to prescribing hepatitis C antiviral therapy in a community setting
Stephen M. Lambert A H , Andrew N. Page B , Johannes Wittmann C , Jeremy S. Hayllar D , Clint W. Ferndale E , Tanya M. Bain F and Graeme A. Macdonald GA School of Medicine, The University of Queensland, 288 Herston Road, Herston, Qld 4051, Australia.
B Discipline of Epidemiology and Biostatistics, School of Population Health, The University of Queensland, 288 Herston Road, Herston, Qld 4051, Australia.
C Department of Gastroenterology, Mater Adult Hospital, Raymond Terrace, South Brisbane, Qld 4101, Australia.
D Alcohol and Drug Service, Metro North Health Service District, Queensland Health, PO Box 8161, Brisbane, Qld 4000, Australia.
E Hepatitis Council of Queensland, 30 Herschel Street Brisbane, Qld 4000, Australia.
F Communicable Diseases Branch, Queensland Health, Level 1, 15 Butterfield Street, Herston, Qld 4006, Australia.
G Department of Gastroenterology and Hepatology and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia.
H Corresponding author. Email: s.lambert@uq.edu.au
Australian Journal of Primary Health 17(3) 282-287 https://doi.org/10.1071/PY10069
Submitted: 4 October 2010 Accepted: 21 February 2011 Published: 5 September 2011
Abstract
There is a growing debate about the prescription of hepatitis C virus (HCV) antiviral therapies within a community setting in Australia. This study aimed to identify interest and confidence among general practitioners (GPs) in prescribing HCV antiviral therapy in a community setting. Data from 580 GPs who responded to a cross-sectional population-based survey were analysed to measure: self-reported interest and confidence in initiating HCV antiviral therapy; and/or prescribing maintenance antiviral therapy; and self-perceived education needs about HCV antiviral therapy. Forty-two percent of respondents indicated they would be interested in prescribing HCV antiviral therapy. Most were not confident to initiate therapy (80%). Higher proportions indicated that they would be more confident in prescribing maintenance therapy (35%) rather than initiating (7%) therapy (z = 10.5, P < 0.001). Confidence in prescribing was related to a higher caseload of patients with HCV (P = 0.001) and being a HIV community-based prescriber (P = 0.002). Fifty-three percent of respondents expressed an interest in education about HCV antiviral therapy. The initial step to recruit potential primary care prescribers of HCV antiviral therapies should be to develop an integrated education program. Recruitment to this program might be most efficient from GPs with a high caseload of patients with HCV.
Additional keywords: maintenance therapy, primary care physician, viral hepatitis.
References
Ascione A, De Luca M, Tartaglione T, Lampasi F, Di Costanzo F, Lanza A, Picciotto F, Marsilia G, Fontanella L, Leandro G (2010) Peginterferon alfa-2a plus ribavirin is more effective than peginterferon alfa-2b plus ribavirin for treating chronic hepatitis C virus infection. Gastroenterology 138, 116–122.| Peginterferon alfa-2a plus ribavirin is more effective than peginterferon alfa-2b plus ribavirin for treating chronic hepatitis C virus infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXht1ajsb0%3D&md5=9b336fa610df9c49cac0227e8818cc2bCAS |
Australasian Society for HIV Medicine (2011) ‘Commencement of the community prescriber hepatitis C treatment initiation pilot March 2010.’ Available at www.ashm.org.au/default2.asp?active_page_id=388 [Verified 2 February 2011]
Australian Government (2004) ‘General Practice in Australia: 2004.’ (Department of Health and Ageing: Canberra)
Australian Medical Workforce Advisory Committee (2005) ‘The general practice workforce in Australia supply and requirements to 2013.’ (New South Wales Health Department: Sydney)
Bhattacharya R, Shuhart MC (2003) Hepatitis C and alcohol: interactions, outcomes, and implications. Journal of Clinical Gastroenterology 36, 242–252.
| Hepatitis C and alcohol: interactions, outcomes, and implications.Crossref | GoogleScholarGoogle Scholar |
Doab A, Treloar C, Dore G (2005) Knowledge and attitudes about treatment for hepatitis C virus infection and barriers to treatment among injecting drug users in Australia. Clinical Infectious Diseases 40, S313–S320.
| Knowledge and attitudes about treatment for hepatitis C virus infection and barriers to treatment among injecting drug users in Australia.Crossref | GoogleScholarGoogle Scholar |
Edith Cowan University (2011) ‘Hepatitis online learning. A resource for health professionals.’ Available at http://hepatitis.ecu.edu.au [Verified 2 February 2011]
Ewart A, Harrison L, Joyner B, Safe A (2004) Providing treatment for hepatitis C in an Australian district centre. Postgraduate Medical Journal 80, 180–182.
| Providing treatment for hepatitis C in an Australian district centre.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c7lvFWhuw%3D%3D&md5=6a29ef882e21520cccf81ded46a14e95CAS |
Fried MW, Shiffman M, Reddy R, Smith C, Marinos G, Gonçales F, Häussinger D, Diago M, Carosi G, Dhumeaux D, Craxi A, Lin A, Hoffman J, Yu J (2002) Peginterferon alfa-2a plus ribavirin for chronic hepatitis c virus infection. The New England Journal of Medicine 347, 975–982.
| Peginterferon alfa-2a plus ribavirin for chronic hepatitis c virus infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD38Xnt12rtb0%3D&md5=ec081a74524adfcd98d75772a8b3abe1CAS |
Gidding HF, Topp L, Middleton M, Robinson K, Hellard M, McCaughan G, Maher L, Kaldor J, Dore G, Law M (2009) The epidemiology of hepatitis C in Australia: notifications, treatment uptake and liver transplantations 1997–2013. Journal of Gastroenterology and Hepatology 24, 1648–1654.
| The epidemiology of hepatitis C in Australia: notifications, treatment uptake and liver transplantations 1997–2013.Crossref | GoogleScholarGoogle Scholar |
Goodyear-Smith F, Whitehorn M, McCormick R (2003) General practitioners’ perceptions of continuing medical education’s role in changing behaviour. Education for Health 16, 328–338.
| General practitioners’ perceptions of continuing medical education’s role in changing behaviour.Crossref | GoogleScholarGoogle Scholar |
Habib S, Adorjany L (2003) Hepatitis C and injecting drug use: the realities of stigmatisation and discrimination. Health Education 62, 256–265.
| Hepatitis C and injecting drug use: the realities of stigmatisation and discrimination.Crossref | GoogleScholarGoogle Scholar |
Hadziyannis SJ, Sette H, Morgan TR, Balan V, Diago M, Marcellin P, Ramadori G, Bodeheimer H, Bernstein D, Rizetto M, Zeuaem S, Pockros P, Lin A, Ackrill A (2004) Peginterferon alfa-2a and ribavirin combination therapy in chronic hepatitis C. Annals of Internal Medicine 140, 346–355.
Hellard M, Yung-Hsuan J (2009) The role of general practitioners in managing and treating hepatitis C. The Medical Journal of Australia 191, 523–524.
Manns M, McHutchison J, Gordon S, Rustgi V, Shiffman V, Reindollar M, Goodman R, Koury Z, Mei-Hsiu Ling K, Albrecht J (2001) Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 358, 958–965.
| Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3MXntF2qtb8%3D&md5=382ea7067faf07d03903cbfee9079b78CAS |
Moreno C, Deltenre P, Pawlotsky J-M, Henrion J, Adler M, Mathurin P (2010) Shortened treatment duration in treatment-naive genotype 1 HCV patients with rapid virological response: a meta-analysis. Journal of Hepatology 52, 25–31.
| Shortened treatment duration in treatment-naive genotype 1 HCV patients with rapid virological response: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXhsFagt7nF&md5=04790b59de731edaf4968fd57835b966CAS |
National Centre in HIV Epidemiology and Clinical Research (2010) ‘HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia annual surveillance report 2010.’ (The University of New South Wales: Sydney)
Parsons J, Warnecke R, Czaja R, Bernsley J, Kaluzny A (1994) Factors associated with response rates in a national survey of primary care physicians. Evaluation Review 18, 756–766.
| Factors associated with response rates in a national survey of primary care physicians.Crossref | GoogleScholarGoogle Scholar |
Pawlotsky J-M, Cocquerel L, Durantel D, Lavillette D, Lerat H, Pecheur E, Polyak S, Tautz N, Thimme R (2010) HCV research 20 years after discovery: a summary of the 16th international symposium on hepatitis C virus and related viruses. Gastroenterology 138(1), 6–12.e1-2.
Queensland Health Department (2001) Final report of the Hepatitic C Pilot Shared Care Project. Available at www.som.uq.edu.au/hivandhcvprojects [Verified 27 September 2010]
Queensland Health Department (2004) Final Report of the HCV GP Education Project. Available at www.som.uq.edu.au/hivandhcvprojects [Verified 27 September 2010]
Queensland Health Department (2009) ‘Highly specialised drug program.’ (Queensland Health: Brisbane)
Shehab T, Orrego M, Chunduri R, Lok A (2003) Identification and management of hepatitis C patients in primary care clinics. The American Journal of Gastroenterology 98, 639–644.
| Identification and management of hepatitis C patients in primary care clinics.Crossref | GoogleScholarGoogle Scholar |
Sibbald B, Addington-Hall J, Brenneman D, Freeling D (1994) Telephone versus postal surveys of general practitioners: methodological considerations. The British Journal of General Practice 44, 297
Sim M, Khong E, Wain T, Rispoli P, Child A, Urzillo D, Garnett-Law B (2009) ‘Hepatitis C Shared Care Project: final report June 2009.’ (Western Australia Department of Health: Perth)
Sood A, Midha V, Awasthi G (2002) Hepatitis C knowledge & practices among the family physicians. Tropical Gastroenterology 23, 198
Spina A (2007) ‘NSW/ACT hepatitis C community prescribing pilot evaluation report.’ Available at www.ashm.org.au/default2.asp?active_page_id=299 [Verified 27 September 2010]
Templeton L, Deehan A, Taylor C, Drummond C, Strang J (1997) Surveying general practitioners: does a low response rate matter? The British Journal of General Practice 47, 91
Thistlethwaite JE, Leeder SR, Kidd MR, Shaw T (2008) Addressing general practice workforce shortages: policy options. The Medical Journal of Australia 189, 118–121.
Tolhurst H, Stewart M (2005) Becoming a GP - a qualitative study of the career interests of medical students. Australian Family Physician 34, 204–206.
Treloar C, Holt M (2008) Drug treatment client’s readiness for hepatitis C treatment: implications for expanding treatment services in drug and alcohol settings. Australian Health Review 32, 570–576.
| Drug treatment client’s readiness for hepatitis C treatment: implications for expanding treatment services in drug and alcohol settings.Crossref | GoogleScholarGoogle Scholar |
Wilkinson D, Dick M, Askew D (2005) General practitioners with special interests: risk of a good thing becoming bad? The Medical Journal of Australia 183, 84
