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Context of Clinical Care: The Case of Hepatitis C in Underserved Communities - A Report from the Primary Care Multiethnic Network (PRIME Net) Consortium
Journal of the American Board of Family Medicine, 11/09/09

Leverence RR et al. – Most (68%) clinicians view HCV as an important problem; more than half (59%) consider screening for HCV to be important when compared with other conditions they screen for in practice. With regard to reported screening habits for risk factors, 54% of clinicians routinely ask new patients whether they have used intravenous drugs and 28% inquire about blood transfusions before 1992. Sixty–one percent order an alanine aminotransferase test when patients present with other risk factors for HCV. The majority of clinicians (54%) refer 75% or fewer of their patients with HCV for treatment; nearly one–fifth (18%) provide antiviral treatment themselves. Key factors influencing clinician HCV decision making are patient comorbidities (74% reported this as a factor), access to treatment (55% reported this as a factor), and tolerance (44% reported this as a factor) of treatment. In the face of conflicting national guideline recommendations about screening people at high risk for HCV, clinicians have varied views and practice habits influenced by multiple patient, access, and treatment issues.

Exclusive Author Commentary
Robert R. Leverence MD, 11/10/09

HCV is a significant public and individual health concern and yet effective treatment exists. With the caveat that long term treatment outcome data is pending, there is otherwise good support and consensus for screening hi-risk individuals. The results of our study suggest that the barriers to HCV screening are mostly an indirect effect of a healthcare system not well equipped to meet the needs of this population. The problem of HCV screening highlights the need for health care reform.