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.
| Discipline Area | Score |
|---|---|
| Nurse |  |
| Physician |  |
Nurse rater
An excellent paper that evidences the importance of GP settings and primary health care in the management of infectious disease. I expect many in the area already have an idea of this, but the study demonstrates it in action.
Nurse rater
This article seems to provide important information to primary care providers.
Nurse rater
This is defintely of relevance to general practice and something that is not currently managed well.
Physician rater
The intervention is usually performed by General Practitioners in Spain from at least 5 years.
Physician rater
The nature of the drug community, and the settings which address it vary immensely. In my community, the status of virtually all such patients is known. In one local practice, with local involvement of an Infectious Disease specialist, the GP clinic itself has managed HepC treatment (Clin Infect Dis. 2005 Jul 1;41 Suppl 1:S73-8.) This article addresses the plans, and the process is well underway.
, McMaster University