Identifying barriers to treatment of HCV in the primary care setting

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.