Barriers to hepatitis C diagnosis and treatment in the DAA era: Preliminary results of a community-based survey of primary care practitioners

2021 ◽  
Author(s):  
Sanjeev Sirpal ◽  
Natasha Chandok
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Economic Status ◽  
Treatment Options ◽  
Linkage To Care ◽  
Primary Care Providers ◽  
Community Context ◽  
World Health ◽  
Survey Study ◽  
Care Providers

Notwithstanding the groundbreaking achievement of hepatitis C curative treatment with direct acting antiviral therapies, Canada faces an uphill battle in reaching the 2030 goal of viral elimination set forth the by the World Health Organization, a goal made more difficult by the COVID-19 pandemic. There is limited understanding of the diagnostic and treatment barriers, and challenges in linkage to care in Canada, especially as it pertains to primary care providers in a community context. Therefore, in this article, the authors conducted a survey study to evaluate the following factors: primary care providers’ knowledge of specialist treatment options and the importance of screening and treatment; and patient factors, including transportation, linguistic barriers, and other socio-economic status indicators that impact the screening and management of hepatitis C. The results suggest that public health campaigns that protocolize and/or incentivize screening and referrals may provide solutions to addressing such barriers.

An Exploration of Barriers Facing Physicians in Diagnosing and Treating Obesity

2018 ◽  
Vol 33 (2) ◽  
pp. 217-224 ◽  
Author(s):  
Ashley Hite ◽  
David Victorson ◽  
Rita Elue ◽  
Beth A. Plunkett
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Treatment Options ◽  
Visual Assessment ◽  
Primary Care Providers ◽  
Survey Study ◽  
Care Providers ◽  
Dietary Counseling ◽  
Diagnosis And Management ◽  
Study Population

Purpose: To determine whether primary care physicians can accurately assess body mass index (BMI) by visual inspection and to assess barriers related to the diagnosis and management of obesity. Design: Prospective Survey Study. Setting: Hospitals and Clinics. Subjects: Primary care providers in the fields of Internal Medicine, Family Medicine and Obstetrics/Gynecology. Measures: Measures investigated included providers visual assessment of BMI, BMI knowledge, diagnosis and management of obese patients, and perceived barriers to treatment. Analysis: Top and bottom quartiles and total scores were determined for responses regarding the reported management of obesity, reported comfort with care, and reported barriers to care and used as the cut point. Statistical analyses were utilized to examine relations and compare groups. Results: 206 (74%) of the 280 eligible providers completed the survey. The accuracy of visual assessment of BMI was 52%. Physicians were more likely to underestimate BMI than overestimate (36% ± 4% vs 12% ± 6%, respectively, P < .001). Although 91% of providers report routinely calculating BMI, only 61% routinely discuss BMI. Providers feel comfortable providing exercise (72%) and dietary counseling (61%). However, fewer are comfortable prescribing medical (16.4%) and surgical options (36%). Conclusion: Visual assessment of BMI is not reliable. Primary care physicians in our study population do not consistently discuss obesity with their patients and many report insufficient knowledge with regard to treatment options. Further studies are needed to determine whether these results are valid for other physicians in various practice settings and to mid-level providers. In addition, research is needed that investigate how collaboration with providers outside the medical field could reduce the burden on physicians in treating patients with overweight or obesity.

scholarly journals A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrew Radley ◽  
Emma Robinson ◽  
Esther J. Aspinall ◽  
Kathryn Angus ◽  
Lex Tan ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Meta Analysis ◽  
Antiviral Drug ◽  
Sustained Viral Response ◽  
Primary Care Providers ◽  
Care Providers ◽  
Hcv Treatment ◽  
Direct Acting Antiviral ◽  
Direct Acting

Abstract Background Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. Methods Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). Results Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). Conclusion Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.

scholarly journals A Hepatitis C Educational Needs Assessment of Canadian Healthcare Providers

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Reza Naghdi ◽  
Karen Seto ◽  
Carolyn Klassen ◽  
Didi Emokpare ◽  
Brian Conway ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Needs Assessment ◽  
Primary Care Physicians ◽  
Healthcare Providers ◽  
Public Health Problem ◽  
Primary Care Providers ◽  
Educational Needs ◽  
Major Public Health Problem ◽  
Care Providers

Background and Aim. Despite advances in the treatment of chronic hepatitis C infection (CHC), it remains a major public health problem in Canada and globally. The knowledge of healthcare providers (HCPs) is critical to improve the care of CHC in Canada. To assess the current knowledge and educational needs of healthcare providers (HCPs) in the area of CHC management a national online survey was conducted. Method. An interprofessional steering committee designed a 29-question survey distributed through various direct and electronic routes. The survey assessed several domains (e.g., participant and practice demographics, access to resources, knowledge of new treatments, and educational preferences). Results. A total of 163 HCPs responded to the survey. All hepatologists and 8% of primary care providers (PCPs) reported involvement in treatment of CHC. Physicians most frequently screened patients who had abnormal liver enzymes, while nurses tended to screen based on lifestyle factors. More than 70% of PCPs were not aware of new medications and their mechanisms. Conclusion. Overall, the needs assessment demonstrated that there was a need for further education, particularly for primary care physicians, to maximize the role that they can play in screening, testing, and treatment of hepatitis C in Canada.

scholarly journals A Primary Care-based Collaborative Hepatitis C Clinic: Clinical Structure and Virologic Outcomes with Direct Acting Antiviral Therapy

2016 ◽  
Vol 3 (1) ◽  
pp. 70-78
Author(s):  
Samuel B. Ho ◽  
Adrian Dollarhide ◽  
Hilda Thorisdottir ◽  
James Michelsen ◽  
Christine Perry ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Adverse Events ◽  
Nurse Practitioners ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Number Of Patients ◽  
Direct Acting ◽  
Collaborative Primary Care

Background: Currently 4 million persons in the US have active hepatitis C virus (HCV) infection and most have never successfully completed antiviral treatment. Newer therapies herald potential for wider uptake and acceptance of treatment, but the number of hepatology specialists is limited and newer models are needed to increase access to care. The aim of this study is to describe a collaborative primary care-based clinic for HCV treatment. Methods: Retrospective analysis of a collaborative primary care clinic developed for the evaluation and treatment of patients with chronic hepatitis C at one VA medical center. A half-day clinic was organized with 4 primary care MDs, 2 hepatologists, 2 nurse practitioners, and a co-located psychiatrist, pharmacist and nurse case manager. Clinic productivity and outcomes related to the number of patients who initiated and completed treatment with direct acting antivirals (DAA) and pegylated interferon and ribavirin were evaluated. Results: In this 18 month period, the clinic had 1890 confirmed HCV registry patients and 1690 clinic visits. 74 HCV genotype 1 patients initiated DAA therapy. Primary care providers treated 47 patients (32% cirrhotic) and hepatologists treated 27 patients (48% cirrhotic). Final SVR rate was 54.6% (39.2% cirrhotics vs. 65.2% noncirrhotics). SVR rates were higher in patients with primary care providers (61.7%) vs. hepatologists (44.4%). Despite numerous adverse events, early treatment termination for adverse events occurred in 5.3% vs. 21.3% for virologic non-response. Multivariate analysis revealed no significant differences between primary care and hepatology for SVR and treatment discontinuations. Conclusion: This clinic demonstrated effectiveness and safety with DAA therapy. This illustrates potential for a primary care based collaborative clinic, which will be crucial for expanding access to effective HCV care.

327 STRATEGIES TO INCREASE CAPACITY TO CARE FOR PATIENTS WITH CHRONIC HEPATITIS C AMONG RURAL PRIMARY CARE PROVIDERS

2020 ◽  
Vol 158 (6) ◽  
pp. S-1268
Author(s):  
Norah Terrault ◽  
Rachel Kanner ◽  
Souvik Sarkar ◽  
Jennifer Slepin ◽  
Lisa Catalli ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Primary Care Providers ◽  
Care Providers ◽  
Rural Primary Care

scholarly journals Tu1507 – Low Cost Hepatitis C Treatment with Generic Sofosbuvir and Ribavirin in Poor Socioeconomic Population in Pakistan by Primary Care Providers

2019 ◽  
Vol 156 (6) ◽  
pp. S-1346
Author(s):  
IMRAN ALAM ◽  
Zohha T. Alam ◽  
SHAHNAZ SAEED ◽  
Naz Shamim ◽  
Nuzhat Rafiqui ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Low Cost ◽  
Primary Care Providers ◽  
Care Providers ◽  
Hepatitis C Treatment

scholarly journals Actionable Analysis: Toward a Jurisdictional Evaluation of Primary Care Access in the Community Context

2019 ◽  
Vol 10 ◽  
pp. 215013271989197
Author(s):  
Mary M. Ford ◽  
Kirsten Weisbeck ◽  
Bonnie Kerker ◽  
Louise Cohen
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Health Care Systems ◽  
Care Facility ◽  
Primary Care Providers ◽  
City Council ◽  
Community Context ◽  
Care Providers ◽  
Primary Care Access ◽  
Care Access

Primary care is the foundation of health care systems and has potential to alleviate inequities in population health. We examined multiple measures of adult primary care access, health status, and socioeconomic position at the New York City Council District level—a unit of analysis both relevant to and actionable by local policymakers. The results showed significant associations between measures of primary care access and health status after adjustment for socioeconomic factors. We found that an increase of 1 provider per 10 000 people was associated with a 1% decrease in diabetes rates and a 5% decrease in rates of adults without an influenza immunization. Furthermore, higher rates of primary care providers in high-poverty districts accepted Medicaid and had Patient-Centered Medical Home recognition, increasing constituent accessibility. Our findings highlight the significant contribution of primary care access to community health; policies and resource allocation must prioritize primary care facility siting and provider recruitment in low-access areas.

scholarly journals Telemedicine Specialty Support Promotes Hepatitis C Treatment by Primary Care Providers in the Department of Veterans Affairs

2017 ◽  
Vol 130 (4) ◽  
pp. 432-438.e3 ◽  
Author(s):  
Lauren A. Beste ◽  
Thomas J. Glorioso ◽  
P. Michael Ho ◽  
David H. Au ◽  
Susan R. Kirsh ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Primary Care Providers ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Care Providers ◽  
Hepatitis C Treatment
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