Kendal Chidwick1, Debra Kiss2, Rachel Gray3, Jeannie Yoo4, Michael Aufgang5, Amany Zekry6. 1. BPharm, MSc Epidemiology, Epidemiology Lead, NPS MedicineWise, Sydney, NSW. 2. PhD, BBiomedSc(Hons), Medical Writer, NPS MedicineWise, Sydney, NSW. 3. BPharm, PGDipClinPharm, Senior Clinical Program Officer, NPS MedicineWise, Sydney, NSW. RGray@nps.org.au. 4. MBBS, MA, FRACGP, Medical Adviser, NPS MedicineWise, Sydney, NSW. 5. MBBS, DipRACOG, FRACGP, Principal GP, Meadows Medical Centre, Melbourne, Vic; Inaugural (now previous) Chair, NFSI Addiction Medicine, RACGP; Board Member, RACGP, VIC. 6. MBBS, FRACP, PhD, Associate Professor of Medicine, St George and Sutherland Clinical School, UNSW; Head of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW; Immediate past Chair, Australian Liver Association.
Abstract
BACKGROUND AND OBJECTIVES: Direct-acting antivirals (DAAs) became available for patients with chronic hepatitis C (CHC) in primary care in March 2016, yet not all patients will have undergone pre-treatment assessment. The aim of this study was to assess where patients with CHC are situated in the diagnosis and care continuum, to encourage general practitioners (GPs) to improve pretreatment assessment and increase DAA treatment uptake. METHOD: This was a cross-sectional study of 4025 adult patients with CHC first recorded between 2013 and 2017, using the general practice data program MedicineInsight. RESULTS: Only half of all patients with confirmed CHC had a hepatitis C virus qualitative RNA recorded, and few patients had all recommended pretreatment assessments. The majority had low aspartate aminotransferase to platelet ratio index (APRI) scores. DISCUSSION: Incomplete pretreatment assessment is likely to be a reflection of the recent shift in management of CHC to primary care. The majority of patients have APRI results that suggest cirrhosis is unlikely, and they are potentially suitable for treatment in primary care. This highlights a substantial opportunity for GPs to recall patients for further assessment and treatment.
BACKGROUND AND OBJECTIVES: Direct-acting antivirals (DAAs) became available for patients with chronic hepatitis C (CHC) in primary care in March 2016, yet not all patients will have undergone pre-treatment assessment. The aim of this study was to assess where patients with CHC are situated in the diagnosis and care continuum, to encourage general practitioners (GPs) to improve pretreatment assessment and increase DAA treatment uptake. METHOD: This was a cross-sectional study of 4025 adult patients with CHC first recorded between 2013 and 2017, using the general practice data program MedicineInsight. RESULTS: Only half of all patients with confirmed CHC had a hepatitis C virus qualitative RNA recorded, and few patients had all recommended pretreatment assessments. The majority had low aspartate aminotransferase to platelet ratio index (APRI) scores. DISCUSSION: Incomplete pretreatment assessment is likely to be a reflection of the recent shift in management of CHC to primary care. The majority of patients have APRI results that suggest cirrhosis is unlikely, and they are potentially suitable for treatment in primary care. This highlights a substantial opportunity for GPs to recall patients for further assessment and treatment.