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Author Topic: Primary Care Docs Less Likely Than Specialists to Get Hep C Treated  (Read 6055 times)

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Offline Hep Editors

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  • Posts: 784
    • Hep Mag
Despite the dramatic rise in referrals to primary care physicians (PCPs) for people testing positive for hepatitis C virus (HCV), PCPs are apparently much less likely than specialists to get such patients treated for the virus.

Presenting their findings in a poster at the Annual Meeting of the American Association for the Study of Liver Diseases in San Francisco, researchers conducted an analysis of data sets from two large national testing laboratory companies. They analyzed 2013 to 2016 data and defined an HCV antibody test as a screening and a positive follow-up HCV RNA test as a diagnosis.

For more...
https://www.hepmag.com/article/primary-care-docs-less-likely-specialists-get-hep-c-treated

Offline Mugwump

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  • My number of posts means nothing, piscor ergo sum!
Re: Primary Care Docs Less Likely Than Specialists to Get Hep C Treated
« Reply #1 on: December 14, 2018, 06:33:52 pm »
Unfortunately the reason why this is occurring is bloody obvious! Far too many primary care MDs are beholden to health insurance corporations. Most likely they are being encouraged to dissuade HCV victims from going on to treat the disease immediately which is proving to be the most rational course of action even if there are no current signs of liver damage occurring with a chronic infection.

As we all know now, the way the disease works in most individuals is a slow downward health spiral which may or may not lead to death from cirrhosis. But certainly leads to all sorts of other expensive to treat medical problems over the years for a great many who are infected with HCV.


 
Caution shameless self promotion below :-)
https://www.hepmag.com/article/eric-reesor-27742-782589663
DING DONG MY DRAGON (HCV) IS FINALLY DEAD!

Offline dragonslayer

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Re: Primary Care Docs Less Likely Than Specialists to Get Hep C Treated
« Reply #2 on: December 17, 2018, 08:08:33 am »
I initially was diagnosed for antibodies by my PCP.  He referred me to a Gastro who ordered the RNA test and made the diagnosis.. I eventually got treated by a Hepatologist.

I think most diagnoses follow a chronology like mine, ie, a PCP notices elevated liver function tests at an annual physical, orders the antibody tests, and if positive, refers to a specialist who treats.  Would  a diagnostic/treatment path such as this be categorized as another PCP who failed to treat?  Could situations like mine have skewed the results?
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Mugwump

  • Member
  • Posts: 778
  • My number of posts means nothing, piscor ergo sum!
Re: Primary Care Docs Less Likely Than Specialists to Get Hep C Treated
« Reply #3 on: December 17, 2018, 12:11:13 pm »
I initially was diagnosed for antibodies by my PCP.  He referred me to a Gastro who ordered the RNA test and made the diagnosis.. I eventually got treated by a Hepatologist.

I think most diagnoses follow a chronology like mine, ie, a PCP notices elevated liver function tests at an annual physical, orders the antibody tests, and if positive, refers to a specialist who treats.  Would  a diagnostic/treatment path such as this be categorized as another PCP who failed to treat?  Could situations like mine have skewed the results?
What I am afraid of is the GPs who are not sending HCV infected individuals who are less affluent up the chain of treatment.

With a judge in Texas ruling that "affordable health care" is unconstitutional, I think it won't be long until this right wing madness spreads north of the border again: Where access to health care is a long standing and well understood constitutional responsibility. 
Caution shameless self promotion below :-)
https://www.hepmag.com/article/eric-reesor-27742-782589663
DING DONG MY DRAGON (HCV) IS FINALLY DEAD!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,545
  • Get tested, get treated, get cured, fight Hep c!
Re: Primary Care Docs Less Likely Than Specialists to Get Hep C Treated
« Reply #4 on: December 17, 2018, 03:23:51 pm »
I had a physical a year before I was diagnosed and my liver enzymes were normal as was my discharge from the Army physical the year before that.

I assuming I was infected for 12 years when I was diagnosed after I donating blood and coincidentally had a work physical at the same time that showed elevated liver enzymes and my blood donation per the blood bank were positive for hep C antibodies.

Back then (1990) there was no HCV RNA testing available but with elevated liver enzymes and positive for hep c antibodies it was assumed.
« Last Edit: December 17, 2018, 03:26:06 pm by Lynn K »
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline dragonslayer

  • Member
  • Posts: 873
Re: Primary Care Docs Less Likely Than Specialists to Get Hep C Treated
« Reply #5 on: December 17, 2018, 08:03:43 pm »
What I am afraid of is the GPs who are not sending HCV infected individuals who are less affluent up the chain of treatment.

With a judge in Texas ruling that "affordable health care" is unconstitutional, I think it won't be long until this right wing madness spreads north of the border again: Where access to health care is a long standing and well understood constitutional responsibility.

Right.. I hear you..   All Im saying is that, while your fear may be sell founded, i dont see evidence of it in any metric used in the study.. I dont even think it was well explained how they defined a PCP who 'didnt treat'..... In other words, did a PCP have to diagnose and then fail to escalate it up the treatment ladder  as you suggest in order to be included in the 'failure to treat' metric, or do they include  PCPs who didnt treat on their own, but did do a referral to a specialist who then treated.. If its the latter, the study results would be meaningless and the conclusion misleading.
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

 


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