Chronic Hepatitis C virus infection in Swiss primary care practices: Low case loads-high barriers to treatment?

Background: The primary care physician (PCP) diagnoses chronic Hepatitis C virus (HCV) infection in most patients. He serves as gatekeeper and plays a key role in counselling and treatment guidance. Objectives: To calculate the approximate HCV caseload per practice and characterize PCPs management of the disease; in particular, to determine antiviral treatment rates and reasons for PCPs for withholding treatment. The ultimate objective was to identify potentially modifiable barriers to treatment. Methods: A confidential self-administered questionnaire centred on the above-mentioned questions was distributed to 2371 Swiss primary care physicians. All respondents of the main questionnaire received an additional small questionnaire focussed on the initial disease workup. Descriptive statistics were used to describe questionnaire responses and PCP demographics. Results : The response rate was 53.1%. Of all participating PCPs (n = 1084), 86.2% reported having patients with chronic HCV, with an average number of 4 patients per practice; 18.6% (n = 142) of PCPs did not monitor their chronic HCV patients. Two-thirds (66.8%) of the sample chronic HCV patient population (n = 4626) never received antiviral therapy. The main reasons given by PCPs for withholding treatment were HCV-specialist advice, patient preference, normal liver enzymes and patient related factors like substance abuse or psychiatric co morbidity. Conclusions: Most PCPs follow patients with chronic hepatitis C, but practice caseloads are low, which may account for insecurity in managing this complex disease.