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Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of
Walter Cullen1, June Stanley, Deirdre Langton
1School of Medicine and Medical Science, University College Dublin, Ireland.
Insights
A general practice intervention significantly increased hepatitis C screening for drug users. This supports primary care
Area of Science:
- Hepatology
- General Practice
- Public Health
Background:
- Hepatitis C is prevalent among injecting drug users, posing challenges for general practice.
- Existing clinical guidelines for hepatitis C management require effective implementation strategies.
Purpose of the Study:
- To evaluate a general practice-based intervention aimed at improving hepatitis C guideline adherence.
- Focus on current or former drug users within primary care settings.
Main Methods:
- Cluster randomized controlled trial involving 26 general practices in Ireland.
- Intervention group received enhanced support for guideline implementation; control group received usual care.
- Screening for hepatitis C and referral pathways for positive cases were assessed.
Main Results:
- Significantly higher rates of hepatitis C screening in the intervention group (adjusted OR 4.53).
- A trend towards increased referrals to hepatology clinics in the intervention group, though not statistically significant (P=0.06).
Conclusions:
- General practices play a crucial role in managing hepatitis C risk in vulnerable populations.
- Supported primary care settings can effectively implement best practices for hepatitis C care.
Background:
Hepatitis C is a common infection among injecting drug users and has important implications for general practice. Although several clinical guidelines concerning the infection have been published, their effectiveness has yet to be tested.
Aim:
To assess the effectiveness of a general practice-based complex intervention to support the implementation of clinical guidelines for hepatitis C management among current or former drug users attending general practice.
Design Of Study:
Cluster randomised controlled trial.
Setting:
General practices in the Eastern Regional Health Authority area of Ireland.
Method:
Twenty-six practices were randomly allocated within strata to receive the intervention under study or to provide care as usual for a period of 6 months. There was screening for patients attending general practice for methadone maintenance treatment for hepatitis C and referral of anti-HCV antibody positive patients to a specialist hepatology department for assessment.
Results:
At study completion, patients in the intervention group were significantly more likely to have been screened for hepatitis C than those in the control group, odds ratio adjusted for clustering 3.76 (95% confidence interval [CI] = 1.3 to 11.3) and this association remained significant after adjusting for other potentially confounding variables, using multiple logistic regression, with the odds ratio adjusted for clustering 4.53 (95% CI = 1.39 to 14.78). Although anti-HCV antibody positive patients in the intervention group were more likely to have been referred to a hepatology clinic, this was not statistically significant (P = 0.06).
Conclusion:
General practice has an important role in the care of people at risk of hepatitis C and when appropriately supported can effectively implement current best practice.
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