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.
RCT Entities:
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.
Authors: J Barry; M Bourke; M Buckley; B Coughlan; D Crowley; W Cullen; S Dooley; S Keating; D Kelleher; J Moloney; F Murray; P A McCormick; P MacMathuna; J O'Connor; J O'Grady; C O'Sullivan; P O'Sullivan; C Quinn; B Smyth; B Sweeney Journal: Ir J Med Sci Date: 2004 Jul-Sep Impact factor: 1.568
Authors: T Poynard; P Marcellin; S S Lee; C Niederau; G S Minuk; G Ideo; V Bain; J Heathcote; S Zeuzem; C Trepo; J Albrecht Journal: Lancet Date: 1998-10-31 Impact factor: 79.321
Authors: J G McHutchison; S C Gordon; E R Schiff; M L Shiffman; W M Lee; V K Rustgi; Z D Goodman; M H Ling; S Cort; J K Albrecht Journal: N Engl J Med Date: 1998-11-19 Impact factor: 91.245
Authors: Antonia F H Smelt; Gerda M van der Weele; Jeanet W Blom; Jacobijn Gussekloo; Willem J J Assendelft Journal: Br J Gen Pract Date: 2010-07 Impact factor: 5.386
Authors: Jeanne Heil; Christian J P A Hoebe; Jochen W L Cals; Henriëtte L G Ter Waarbeek; Inge H M van Loo; Nicole H T M Dukers-Muijrers Journal: Ann Fam Med Date: 2018-01 Impact factor: 5.166
Authors: Emma Day; Margaret Hellard; Carla Treloar; Julie Bruneau; Natasha K Martin; Anne Øvrehus; Olav Dalgard; Andrew Lloyd; John Dillon; Matt Hickman; Jude Byrne; Alain Litwin; Mojca Maticic; Philip Bruggmann; Havard Midgard; Brianna Norton; Stacey Trooskin; Jeffrey V Lazarus; Jason Grebely Journal: Liver Int Date: 2018-09-22 Impact factor: 5.828
Authors: Jason Grebely; Julie Bruneau; Jeffrey V Lazarus; Olav Dalgard; Philip Bruggmann; Carla Treloar; Matthew Hickman; Margaret Hellard; Teri Roberts; Levinia Crooks; Håvard Midgard; Sarah Larney; Louisa Degenhardt; Hannu Alho; Jude Byrne; John F Dillon; Jordan J Feld; Graham Foster; David Goldberg; Andrew R Lloyd; Jens Reimer; Geert Robaeys; Marta Torrens; Nat Wright; Icro Maremmani; Brianna L Norton; Alain H Litwin; Gregory J Dore Journal: Int J Drug Policy Date: 2017-07-03