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 17 January 2018

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News

Primary care physicians need help to identify HCV risk

Researchers in America have called for better mechanisms to enable doctors to identify those at risk of Hepatitis C and ensure they get tested while there is still time for treatment.

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The call follows new research that shows people infected with the potential fatal virus are not getting tested early enough or often enough, and are not always being referred for specialty care.

The research, by University of Michigan Health System, found that among a sample of the 2,348 HCV screening tests ordered by primary care physicians, only a quarter were ordered because the doctor identified the patient as having a potential risk factor. The risk factors included intravenous drug use or a blood transfusion before 1992.

Another 65% had the test because of prior liver problems, or because routine blood tests showed elevated liver enzymes. 10% of patients requested it.

Of all those tested, 10% turned out to be infected, and about half were referred to a specialist for follow-up.

Meanwhile, almost half of the 57 patients who tested positive and went on to have a liver biopsy had significant liver scarring - either cirrhosis or fibrosis - suggesting a long-standing infection.

Primary care doctors need to investigate HCV risk factors in patients.
Digestive Disease Week

The results of the study were presented at the Digestive Disease Week meeting in Atlanta.

University of Michigan Medical School gastroenterology professor, Dr Anna Lok, said primary care doctors were the gatekeepers of the health care system, and it was crucial they caught the infection early by asking about risk factors, ordering tests, and referring those who test positive for evaluation and treatment.

She commented that patients were also responsible for volunteering the information to their doctors, despite the perceived stigma of the virus.

University fellow, Dr Thomas Shehab, said general physicians were being expected to screen for more and more diseases, and the results showed that they needed help to do it in a way that was efficient and effective.

The study contradicted the views of many primary care physicians, who thought they did a good job of assessing patients for their hepatitis C risk and referring them for treatment.

The new study did not examine why a higher percentage of patients were not tested based on risk factors, or what reasons might have stopped them getting a referral, such as a patient's age or other health problems.

"Ideally, early diagnosis can be made if doctors ask about hepatitis C risk factors and patients answer honestly. We shouldn't wait until patients have symptoms, or until the infection has progressed, as treatment is often more effective if it's begun earlier," said Dr Lok.

"In addition, there are important potential benefits to the public at large of early diagnosis. These include the fact that hepatitis C patients may change behaviors and therefore reduce the risk of transmission to others, and the possibility that they may modify practices such as alcohol consumption that may alter the disease's progression."

The researchers hope to add screening questions about HCV risk factors to questionnaires handed to patients in primary care clinics, or to find ways to use technology to make the process more efficient.

Report Copyright: Englemed Health News at http://www.internationalmedicalnews.com

Digestive Disease Week
25 May 2001

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