Author: Jane Scarborough
Scarborough, Jane, 2021 Looking after them? The provision of care for people affected by hepatitis C - in private general practice in South Australia, Flinders University, College of Medicine and Public Health
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With more than 1% of the Australian population chronically infected, hepatitis C virus (HCV) is a significant contributor to morbidity and mortality in Australia. Whilst direct acting antiviral treatment for HCV (DAA) with high cure rates is now available for Australian people with HCV (PWHCV), there remains a substantial proportion of the affected population who remain undiagnosed and untreated. Australian private General Practitioners (GPs) are professionally and geographically well placed to diagnose HCV and prescribe DAA, yet there are gaps in the care provided by these GPs.
The original contribution to knowledge in this thesis is the presentation of additional recommendations to increase the provision of DAA in this setting, that originate from a re-examination of the assumptions about the provision of care within the GP-patient relationship in the Australian context. A strength of this thesis is the in-depth understanding of this context provided by studies focused on the ‘healthcare system’ (Study 1), ‘patient’ (Study 2) and ‘GP’ (Study 3) system components individually, and the interactions between these.
A document analysis of HCV specific and two broad primary healthcare policies, Study 1, demonstrated a lack of coherence between the documents that prevented equity of healthcare access for PWHCVs. Recommendations to facilitate cross-referencing between the disease specific and broad policies are provided. Semi-structured interviews were thematically analysed in Study 2 and Study 3, respectively examining the experiences and perspectives of people affected by HCV, regarding engagement for HCV care (N=22), and the experiences and perspectives of GPs with the provision of this care (N-=9). Decisions about engagement and disclosure to GPs were made by PWHCV by weighing up their perceptions of the potential risks and potential benefits. Potential risks included risk to the confidentiality of sensitive information, risk to usual care and risk of exposure to discrimination. For PWHCV the perception of benefit would only occur if the GP was capable of providing an appropriate level of care and this was not assumed for all GPs. GPs described limits to their scope of practice and that inclusion of prescribing DAA was not automatic. The perceived prevalence of conditions within their patient population influenced GPs’ scope of practice. GPs considered the provision of DAA as a ‘special interest’. GPs that provided DAA felt confident and supported to provide this care.
The overall conclusion is that GPs will not automatically provide care for HCV to ‘their’ patients and PWHCV will not always engage with ‘their’ GP for this care. While the profession of general practitioners is appropriate to provide DAA, not all GPs will choose to include this care in their scope of practice. Australian PWHCV also have choice about their engagement with individual GPs and about disclosure of HCV. Suggested recommendations centred around supporting GPs who choose to provide HCV care to provide best-practice care and providing pathways for PWHCV to receive care from these GPs. GP-to-GP referral, expansion of the role of Viral Hepatis Nurses, and a register of GP DAA providers, are amongst recommendations provided to achieve this outcome.
Keywords: Hepatitis C, HCV, GP, General Practitioner, general practice, family practice, primary care, primary healthcare, primary health care, scope of practice, provision of care, continuity of care
Subject: Public Health thesis
Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Medicine and Public Health
Supervisor: Dr Emma Miller