Q J Med 2004; 97: 549-550
QJM vol. 97 no. 8 © Association of Physicians 2004; all rights reserved.
Correspondence |
Improving general practitioners' knowledge of chronic hepatitis C infection
Sir,Chronic infection with the hepatitis C virus (HCV) affects over 170 million individuals worldwide1 and is a major healthcare concern in the UK. Primary care physicians are often the first health-care professionals to see infected individuals. In the UK, general practitioners (GPs) still have little knowledge about hepatitis C, despite a public campaign,2 this is comparable with other countries such as Australia and America.3,4
We attempted to improve knowledge regarding HCV by holding educational programmes consisting of lunch-and-learn sessions accommodating 150 GPs, and assessing knowledge of HCV with a standardized pre-test and post-test questionnaire. We incorporated five key elements into these meetings: value to healthcare staff, incentives, repeated exposures, commitment by clinicians and an exceptionally well-organized implementation plan that has previously been shown to produce successful educational programmes.5 A postal survey was also sent out to 200 GPs with a one-page information sheet on HCV, again with pre and post-test assessment of knowledge.
Of 150 GPs, 43 (29%) attended the lunch and learn sessions, while 164/200 GPs (82%) took part in the postal survey. Those who did not attend were asked why they did not, and 91/107 who could be contacted, replied that they were unable to obtain clinical cover.
Following the educational meetings and the postal surveys, all eight questions had a significant improvement in the percentage of correct responses (Table 1). The percentage of correct responses following the post-test were >85%.
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In the open-ended questions, GPs were asked to list the groups of patients they would screen for HCV; 168 (81%) were able to list more than three groups who should be screened for chronic HCV, compared to their performance pre-test when only one, or an inappropriate group, was described as requiring screening. GPs were asked about ways in which HCV services could be improved. They were aware of ways of improving HCV services such as increased drug counselling facilities, needle exchange services and provision of harm minimization information and activities to prevent transmission of HCV. Ninety-five (46%) expressed frustration regarding access to reliable information about treatment algorithms, and to linguistically and culturally appropriate patient information.
Our previous survey showed that following the UK Department of Health information campaign in HCV, the knowledge of East London GPs was still poor.2 To address this issue, we launched an information campaign, and this has effectively increased GPs awareness and knowledge of chronic HCV. However, we only assessed knowledge immediately after completion of the education session and, clearly, such a testing regime does not address knowledge retention. The lunchtime educational sessions were relatively poorly attended and labour-intensive, and it may be more efficient to inform general practitioners using postal information leaflets. However in this study, GPs were asked to complete a questionnaire after reading the leaflet, and this may have contributed to the knowledge retention that was achieved.
Educational programmes and postal surveys can serve as a model to provide educational programmes to health professionals. Thus, educational initiatives and guidelines specifically designed for GPs are needed to assist them in identifying patients at risk, conducting initial diagnostic evaluation, and initiating appropriate referrals, so that patients with hepatitis C can be correctly diagnosed and treated while they are still in the early stages of disease. The best method of providing information should be provided, and GPs may wish to become more directly involved in shared care arrangements with specialists that will broaden education and treatment opportunities for HCV-infected patients.
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Hepatobiliary Group
Department of General Practice and Primary Care Barts and The London Queen Mary's School of Medicine and Dentistry London e-mail: g.r.foster{at}qmul.ac.uk
References
1. WHO. Global surveillance and control of hepatitis C. J Viral Hep 1999; 6:35–47.
2. D’Souza R, Glynn M, Alstead E et al. Knowledge of chronic hepatitis C in East London primary care physicians following the Department of Health's Educational Campaign. Q J Med 2004; 97:331–6.
3. Shehab TM, Sonnod SS, Lok AS. Management of hepatitis C patients by primary care physicians in the USA: results of a national survey. J.Viral Hepat 2001; 8:377–83.[Medline]
4. Gupta L, Puech M, Ward J. Service expectations, self-reported educational and resource needs of general practitioners in managing patients with hepatitis C. Drug Alcohol Rev 2000; 19:65–71.[CrossRef]
5. Fischer L, Conboy K, Tope D et al. Educating Health Professionals: A Hepatitis C Educational Program in a Health Maintenance Organisation. Am J Manag Care 2000; 6:1029–36.[Medline]
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