A recent study evaluated the hepatitis C knowledge of primary care residents at five training programs, finding significant gaps:
- Only 41% of residents would vaccinate patients with hepatitis C against hepatitis A; only 19% knew the correct hepatitis A vaccination schedule
- Only 65% of residents would vaccinate patients with hepatitis C against hepatitis B; only 78% knew the correct hepatitis B vaccination schedule
- 66% recommended vaccination against hepatitis C -- though no hepatitis C vaccine exists
- Only 53% of residents would recommend a liver biopsy before deciding to treat hepatitis C
- Only 52% correctly identified interferon alpha and ribavirin as standard treatment for hepatitis C
- 69% of residents felt they did not have enough information about hepatitis C
These results came from a survey of primary care residents; presumably liver specialists (e.g., gastroenterologists) would be better informed. Nevertheless, primary care is critical for initial diagnosis of hepatitis C, and may play an increasing role in on-going hepatitis C care and treatment in the future. This report underscores the need for further training for medical school students, residents, and physicians and other health care professionals.
Full abstract follows:
The American Journal of Gastroenterology
Volume 99 Issue 9 Page 1720 - September 2004
Hepatitis C Knowledge among Primary Care Residents: Is Our Teaching Adequate for the Times?
Angelo G. Coppola, M.D., Pietor C. Karakousis, M.D., David C. Metz, M.D., Mae F. Go, M.D., M. Mhokashi, M.D., Colin W. Howden, M.D., F.A.C.G., Jean-Pierre Raufman, M.D., F.A.C.G., and Virender K. Sharma, M.D.
BACKGROUND: Increasingly, primary care (PC) physicians will be the first to encounter patients with hepatitis C virus (HCV) infection.
AIM: To determine opinions and practices of PC residents regarding HCV.
METHODS: We administered a one-page questionnaire to 180 PC residents at five U.S. training programs.
RESULTS: Respondents were distributed equally across postgraduate year, 83% were U.S. graduates, and 44% had seen >11 (HCV) patients in the past year. Residents tested for HCV in persons with: increased transaminases (83%), history of blood transfusion (46%), multiple tattoos (57%), +ANCA (16%), and alcohol abuse (31%). Sixteen percent of respondents tested all patients. Forty-one percent would vaccinate HCV patients for hepatitis A and 65% for hepatitis B while only 19% and 78% knew the respective vaccination schedules. Although no vaccine is available, 66% recommended vaccination for HCV. Only 37% and 29%, respectively, reported HCV genotype 1 as most common and most resistant to treatment. Fifty-three percent recommend liver biopsy before treating HCV. Only 52% reported alpha interferon (IFN) with ribavirin as initial treatment for HCV while 28% recommend ribavirin or lamivudine alone or combinations of IFN and lamivudine or amantadine. As contraindications to treatment, 33% reported AIDS with PCP infection, 19% coronary artery disease, and 19% suicidal ideation. Sixty-nine percent felt that there was insufficient information on HCV.
CONCLUSIONS: Many PC residents lack adequate knowledge of recommended guidelines for the management of HCV. Many test for HCV in inappropriate situations, are unclear regarding available vaccines and their administration, and are uncertain about current treatment. Education of PC residents on guidelines for detection and management of HCV must be improved.