Investigating general practice and hepatitis B

There is an increasing burden on the community resulting from chronic hepatitis B infection. General Practitioners (GPs) are essential in reducing this burden given strong evidence showing that the early detection, follow-up and treatment of chronic hepatitis B can slow the progression to liver failure and reduce the chance of being diagnosed with liver cancer. The Australian National Hepatitis B Strategy 2010-2013 describes ‘general practice as part of a healthcare team... central to the healthcare experience of people living with chronic hepatitis B.’ Given indications of a less than optimal response to chronic hepatitis B by GPs in Australia, this study conducted qualitative interviews with 26 GPs to identify their understanding of their role, and perspectives on the barriers and challenges to the effective diagnosis and management of chronic hepatitis B in general practice. The GPs who participated in the study had been practicing for between three and 37 years with most working for ten years or more, and eight having practiced for over 30 years. About two-thirds of the participants communicated with their patients in at least one language other than English, with most speaking one or several Chinese languages, and Vietnamese. The number of patients with chronic hepatitis B cared for by the GPs was estimated to range from at least four patients, with 13 GPs caring for over 30 patients, including five GPs who cared for more than 100 patients. Participants recognised the fundamental role GPs have in managing chronic hepatitis B with several stating that as a primary provider of health care in the community, GPs are uniquely positioned to support the screening and life-long monitoring of the infection. The recurring interaction between GPs and patients can lead to the establishment of trusting therapeutic relationships that often continue after patients have been referred to a tertiary service. GP knowledge about chronic hepatitis B was identified as a key challenge for providing an effective clinical response. Almost all GPs identified a need for further education. Knowledge deficits related to the changes in specialist practices over the past decade as a result of a better understanding of the natural history of hepatitis B and improved treatment modalities