A cluster randomised controlled trial of a MedicineInsight Educational QUality Improvement Program to improve the diagnosis and treatment of chronic HEPatitis C in general practice (the EQUIP‐HEPC trial)

The availability of direct acting antivirals (DAAs) sparked efforts to eliminate hepatitis C virus (HCV) in Australia. We evaluated whether an educational intervention of a 1-hour discussion among staff using audit and feedback data from MedicineInsight GP program would improve DAA uptake. Of 296 eligible general practices in MedicineInsight 11% opted out. Randomisation stratified by practice caseload allocated 130 practices to the intervention arm and 129 to control. The primary outcome was the number of patients started on DAAs over 6 months using the negative binomial regression model adjusted for DAA prescribing history and clustering by practice. Data for analysis were available for 78% of practices, which included 101 practices and 2,469 DAA-naive patients with confirmed/possible HCV in the intervention arm; and 100 practices and 2,466 patients in the control arm. At baseline: 49.5% of practices had prescribed ≥1 DAA in the past year; 18.9% of HCV patients had already been treated with DAAs; the mean age of DAA-naive HCV patients was 43 years and 57% were male. Over 6 months, 43 patients in the intervention arm and 36 in the control arm started DAAs (adjusted IRR 1.19; 95% CI 0.67-2.11, p=0.55). In the first 3 months 27 vs 16 patients started DAAs (adjusted IRR 1.77, 0.88-3.58; p=0.111). Few patients were started on DAAs and a facilitated discussion in HCV management did not lead to a significant increase. Alternative measures, such as incentivising GP initiations or patients, are suggested to address remaining barriers to DAA uptake in Australian primary care.

留言 (0)

沒有登入
gif