S1269 Screening, Referral Practice and Management of Hepatitis B and C in Primary Care: A Survey of General Practitioners

Introduction In order to optimise our viral hepatitis service, we wished to assess the knowledge and referral practice of primary care physicians in our local area. General practitioners (GPs) have a vital role in the identification of patients who require screening for hepatitis B (HBV) and C (HCV), referring appropriately, and in supporting treatment in conjunction with the hepatitis clinic. The area around QEH has a prevalence rate of 3% positive HBsAg in the antenatal population and ∼100 new positive HCV antibody tests per year. Aim to assess GP knowledge of and attitudes to HBV and HCV with respect to transmission, screening, serological tests, referral to secondary care and treatment. Methods A survey containing 32 questions was sent to GPs within our catchment area. Where there was no response after several months, the questionnaire was reissued. Results 45/161 (28%) questionnaires were completed and returned. Demographics: Mean age 46 years (20f; in general practice 14 years (1–35); 96% of practices had >5000 patients. 90% of respondents would attend an educational seminar on viral hepatitis. Only 36% of GPs thought all patients with chronic HBV should be managed in secondary care, compared with 59% for HCV. 8/45 (17%) knew how to correctly screen for HBV and 30/45 (67%) knew how to assess response to HBV vaccination. Two scenarios for HBV were presented: a pregnant woman found to be surface antigen positive on screening; and a Nigerian man known to be surface antigen positive, who had an alanine aminotransferase (ALT) four times the upper limit of normal. Only 24/45 and 16/45, respectively, would refer these patients to a specialist. Further scenarios for HCV: an asymptomatic woman with a reactive HCV antibody at blood donation and normal ALT; and an asymptomatic man with a reactive HCV antibody and an ALT five times the upper limit of normal, yielded 21/45 and 29/45 potential referrals, respectively. Conclusion Without a basic understanding of chronic viral hepatitis, including a knowledge of who and how to screen for HBV and HCV, and when to refer, a significant proportion of patients will not receive appropriate treatment. In the longer term this will result in an increased incidence of the complications of HBV and HCV with important implications for hepatology services. Improved training and education are required for general practitioners and hospitals should provide clear management guidelines to local GPs.