What Can We Learn from Hep C Engaged GPs?

(A report on the end of day discussion panel featuring Dr Sam Elliott, Dr Annie Balcomb, Dr Joss O’Loan, Dr Belinda Greenwood-Smith, Dr Heather McNamee, and Dr Zak Baig)

Takeaway lessons from the end of day discussion panel: 

  • It is a minimum requirement for GPs to screen for hepatitis C correctly, diagnose and then refer or treat if required. We cannot have GPs carrying the workload on their own; it is up to GPs whether they want to upskill and treat patients with hepatitis C. However they cannot choose not to screen and diagnose. Screening and diagnosis of Hep C will be the main work of GPs in the future. 
  • It is important to target GPs in the middle of the awareness curve, as early adopters are already well engaged. We need to try to disseminate knowledge to the next wave of GPs. Increasing awareness in GP annual conferences will help. This information needs to be in the plenary session of the annual RACGP conference. 

  • Different approaches may be needed to motivate GPs working in high versus low prevalence clinics. GPs working in high prevalence populations need to upskill – this is worthwhile due to the number of patients they have that need to be treated. GPs working in low prevalence settings might need easy access to specialists, or to a specialist GP. We need various approaches side by side to be successful in supporting GPs  

  • ASHM has an existing list of trained GPs with hep C experience. Lists and tools like this need to be publicised more widely. A barrier is that often newly skilled GPs do not want to add themselves to ASHM’s list of experienced GPs. (link to https://www.ashm.org.au/HCV/hcv-prescriber-list/)    

  • GPs can conduct an audit to check for Hep C in past histories of current patients, then offer up to date testing. If a GP has lots of patients with Hep C found in an audit:  

  • Find a colleague in the practice to work with 

  • Find a nurse that can be trained up and do the preparation and work up to a set template for them to follow 

  • Get in contact with the local liver clinic that may be able to come to the clinic to support with specialist support   

  •  You need a few motivated individuals to push the agenda of Hep C treatment and cure. GPs can become Hep C champions like in Cairns, where they are challenging themselves to be the first Hep C free prison. 

  • High turnover of practitioners in remote areas is a barrier, therefore an institutional culture is required to make it sustainable including nurses and practice nurses up skilled in the long term.  

  • Addressing issues of stigma and discrimination in GPs is very important.  

  • Risk of burnout in GP is a real issue and this is an important issue to consider. 

  • There are lots of patients with hepatitis C who go undiagnosed and GPs will have to find them. Suggestions for doing this include: 

    • Adding a page to the intake questionnaire used in a General Practice which includes drug and alcohol use -current and past drug use - patients are more honest in filling forms than face to face questions on risk behaviour. 
    • Testing for Hep C should be a standard part of liver function abnormality screening  
    • Methadone or Suboxone prescribers should add BBV screening as part of the patient’s normal work up for Opiate Substitution Therapy.  
    • Screening patients with fatty liver for hepatitis C – hepatitis C in these patients may be missed by GPs. 
    •  Hep C mapping of populations with higher rates will help targeted awareness raising, testing and treatment (link to https://www.ashm.org.au/HCV/hepatitis-c-mapping-reports/
    •  Public awareness campaigns both for patients and doctors will be essential.  
    • Normalise Hep C testing as part of liver cancer prevention especially in CALD populations eg.  same as mammogram and PAP screening  
    • In mental health settings, long term patients cannot get subsidised treatment for Hep C. This is a major barrier to treatment.   
    • People in the CALD community have low levels of awareness and literacy around the different types of hepatitis.  
    • Offer Hep C testing to young people with regular STI screening - test hep B and C if they have been around people that have injected drugs.  

 

Author bio:  

Dr Simon Slota-Kan is a General Practitioner and Public Health Physician from Victoria that prescribes opiate replacement therapy working in a suburban general practice and university health service.