Trends in chronic hepatitis C visits by providers in Quebec, Canada: A population-level cohort study

Despite primary care's role in hepatitis C elimination, evidence of primary care providers' involvement remains limited. To enhance our knowledge of health care use among hepatitis C-infected individuals, we described trends in hepatitis-related visits and patients' characteristics by provider specialty in Quebec.

We conducted a population-based cohort study using all hepatitis C cases in the Quebec Mandatory Reportable Disease database (1990-2018), linked with the provincial physician billing database. We described monthly rates of hepatitis-related medical visits using a generalized additive model across different provider specialties and stratified our results by at-risk populations.

Between 1990 and 2018, 37,251 patients were diagnosed with hepatitis C. Visit rates were lower for other specialties compared to gastroenterologists; rate ratios (RRs) were 0.73 (95% CI 0.67-0.79) for general practitioners/family physicians (GPs/FPs) and 0.24 (95% CI 0.21-0.26) for internal medicine physicians. The RR for GPs/FPs was 1.21(95% CI 1.05-1.39) among people who inject drugs (PWID), 0.76 (95% CI 0.71-0.82) among the 1945-1975 birth cohort, and 0.37 (95% CI 0.28-0.49) among immigrants, compared to gastroenterologists. Patients seen primarily by GPs/FPs were more likely to have a history of drug use and mental health disorders than those seen by specialists.

Hepatitis C cases were more likely to be seen by gastroenterologists than by GPs/FPs in Quebec from 1990 to 2018. However, GPs/FPs had higher visit rates for PWID. Specialists more often managed immigrants and the 1945-1975 cohort. These findings suggest disparities in care access and emphasize GPs/FPs' role in managing hepatitis C among marginalized populations.