Primary Care Physician Perspectives on Hepatitis C Management in the Era of Direct-Acting Antiviral Therapy

Mary Thomson, Monica A. Konerman, Hetal Choxi, Anna S. F. Lok

Primary care physicians (PCPs) play a critical role in the care cascade for patients with chronic hepatitis C (CHC). To assess PCP knowledge and perspectives on CHC screening, diagnosis, referral, and treatment. An anonymous survey was distributed to PCPs who participated in routine outpatient care at our hospital. Eighty (36 %) eligible PCPs completed the survey. More than half were females (60 %) aged 36-50 (55 %) from family (44 %) or internal (49 %) medicine. Overall, PCPs correctly identified high-risk populations for screening, though 19 % failed to identify baby boomers and 45 % failed to identify hemodialysis patients as populations to screen. Approximately half reported they were able to screen at risk patients <50 % of the time secondary to time constraints and difficulty assessing if patients had already been screened. 71 % of PCPs reported they refer all newly diagnosed patients to specialty care. 70 % of PCPs did not feel up to date with current treatment. The majority grossly underestimated efficacy, tolerability and ease of administration, and overestimated treatment duration. Only 9 % felt comfortable treating CHC, even those without cirrhosis. Practice patterns were influenced by specialty and Veterans Affairs Hospital affiliation. Although the majority of PCPs are up to date with CHC screening recommendations, few are able to routinely screen in practice. Most PCPs are not up to date with treatment and do not feel comfortable treating CHC. Interventions to overcome screening barriers and expand treatment into primary care settings are needed to maximize access to and use of curative therapies.