THE broad prescribing authority for direct-acting antivirals (DAAs) for hepatitis C has allowed a large number of GPs to take part, increasing GP confidence and improving care for their patients, say experts.

DAA therapy has been available for people with chronic hepatitis C through the Pharmaceutical Benefits Scheme (PBS) since March 2016, and all clinicians, including GPs, can prescribe.

Researchers led by Dr Behzad Hajarizadeh, a Senior Lecturer at the Kirby Institute, analysed PBS data for DAA dispensed to people with chronic hepatitis C during March 2016 ‒ March 2020. Prescribers were categorised into three broad groups: GPs, main specialist groups, and other prescribers.

The study, published by the MJA, found that GPs now make up almost half of DAA prescribers.

“During [the study period], 82 694 people with hepatitis C received DAA treatment, prescribed by GPs in 36 098 cases (44%), by specialists in 42 585 cases (51%), and by other prescribers in 4011 cases (5%),” Hajarizadeh and colleagues wrote.

“Long duration treatment (16–24 weeks), prescribed for patients with more complex disease (eg, cirrhosis, previous failed hepatitis C treatment), was prescribed less frequently by GPs (2188 patients; 6%) than by specialists (5822 patients; 14%).

“A total of 6187 GPs prescribed DAA treatment for at least one patient (18% of 33 556 registered GPs in 2019).

“The number of GPs who prescribed DAA as new prescribers was 1863 in 2017 (83% of new prescribers), 1282 in 2018 (78%), and 943 in 2019 (71%). Almost half the prescribing GPs (48%, 2986 of 6187) and 14% of prescribing specialists (112 of 811) had prescribed DAA therapy for one patient only; 10% of GP prescribers (630 of 6187) and 58% of specialist prescribers (469 of 811) had treated ten or more patients.”

The authors concluded that: “The continuing increase in the number of GPs prescribing DAA and the number treating single patients suggest that GPs are gaining confidence in prescribing DAA therapy.

“This is an important foundation for further enhancing access to treatment.”

In July of 2017, the MJA published a Perspective that identified that GP involvement in DAA therapy had increased from 4% to 19% just in the first 6 months of DAA availability under the PBS.

“Continuity of GP care creates further opportunities to monitor the long term effectiveness and safety of DAAs,” the authors wrote.

“More importantly, the whole person approach in general practice is fundamental to managing frequent comorbidities, such as mental health, chronic diseases and concomitant misuse of alcohol or other drugs.”

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