Related Experiment Videos
Current practice patterns of primary care physicians in the management of patients with hepatitis C
T M Shehab1, S S Sonnad, M Jeffries
1Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
Insights
Primary care physicians often correctly identify hepatitis C virus (HCV) risk factors and manage patients, but confusion persists regarding HCV testing and interferon treatment efficacy. Educational programs are crucial for improving HCV screening and patient management.
Area of Science:
- Hepatology
- Infectious Diseases
- Primary Care Medicine
Background:
- Hepatitis C virus (HCV) infection affects millions, often asymptomatic until advanced liver disease.
- Primary care physicians (PCPs) are vital for early HCV detection and management of at-risk individuals.
Purpose of the Study:
- To assess PCPs' knowledge of HCV risk factors.
- To evaluate PCPs' management strategies for HCV antibody-positive patients.
- To identify gaps in PCP understanding of HCV testing and treatment.
Main Methods:
- A survey was administered to 1,233 PCPs in a health maintenance organization (HMO).
- Physicians' knowledge of HCV risk factors and management of hypothetical HCV-positive cases were assessed.
- Response rate was 33% (404 physicians).
Main Results:
- 90% of PCPs correctly identified HCV risk factors, though 20% still cited 1994 blood transfusions.
- Management varied: 62% would refer patients with abnormal alanine transaminase (ALT), 33% would manage in-house.
- Significant confusion existed regarding interferon treatment efficacy (43% overestimated, 29% unsure) and repeat HCV antibody testing (65%).
Conclusions:
- While PCPs generally identify HCV risk factors and manage hypothetical cases appropriately, significant confusion exists regarding diagnostic testing and treatment effectiveness.
- Targeted educational interventions are necessary to enhance PCP proficiency in HCV screening, further evaluation, and patient management.
- Improving PCP knowledge is essential for effective implementation of hepatitis C screening protocols.
Abstract:
Approximately 4 million Americans are infected with the hepatitis C virus (HCV). Most patients with hepatitis C have no symptoms until cirrhosis is established. Thus, initial diagnosis and management of hepatitis C rely on primary care physicians identifying and screening high-risk individuals. We administered a survey to 1,233 primary care physicians in a health maintenance organization (HMO) in April 1997 to assess their knowledge of the risk factors for HCV infection and approach to the management of 2 hypothetical HCV antibody-positive patients, 1 with elevated and the other with normal alanine transaminase (ALT). Four hundred four (33%) physicians returned the survey. Ninety percent of respondents correctly identified the risk factors for HCV infection, but 20% still considered blood transfusion in 1994 as a significant risk factor for HCV infection. Sixty-two percent of respondents would refer HCV antibody-positive patients with abnormal transaminase levels, but 33% would follow these patients themselves, even though none of the respondents had treated any hepatitis C patient on their own. Forty-three percent of respondents overestimated, while 29% did not know the efficacy of interferon treatment. Sixty-five percent of respondents would retest patients for HCV antibody, regardless of risk factors and transaminase levels. We found that most primary care physicians correctly identified the significant risk factors for HCV infection and appropriately managed the 2 hypothetical patients, but there was considerable confusion about the use of HCV tests and the effectiveness of treatment. Educational programs for primary care physicians are needed to implement hepatitis C screening and to initiate further evaluation and management of those who test positive.