Physicians' attitudes and practice toward treating injection drug users with hepatitis C: results from a national specialist survey in Canada
- PMID: 21499577
- PMCID: PMC3076031
- DOI: 10.1155/2011/810108
Physicians' attitudes and practice toward treating injection drug users with hepatitis C: results from a national specialist survey in Canada
Abstract
Background: In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care.
Objective: To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs.
Methods: A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes⁄no), and examined how a physician's treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service.
Results: Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians' type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]).
Conclusion: The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs.
HISTORIQUE :: Au Canada, plus de 70 % des nouveaux cas d’infection par le virus de l’hépatite C (VHC) par année sont des consommateurs de drogues injectables (CDI). Il n’y a pas de consensus pour l’instant sur la manière de leur offrir des soins médicaux.
OBJECTIF :: Examiner les caractéristiques des médecins spécialistes canadiens et la probabilité qu’ils dispensent un traitement aux patients ayant un VHC qui sont des CDI.
MÉTHODOLOGIE :: Les chercheurs ont mené une étude transversale nationale dans les domaines de spécialité de l’hépatologie, de la gastroentérologie et de l’infectiologie afin d’examiner les services sur le VHC. Le questionnaire comprenait des questions sur les données démographiques de base, les voies d’aiguillage et les opinions (oui ou non) et permettait d’évaluer à quel point le schéma thérapeutique d’un médecin est influencé par des facteurs comme l’admissibilité au traitement, la prise en charge des soins du VHC et les obstacles à offrir des services de qualité.
RÉSULTATS :: Même si la majorité des cas prévalents et incidents de VHC s’associent à la consommation de drogues injectables, très peu de médecins spécialistes dispensent la thérapie nécessaire à cette population. Seulement 19 (19,79 %) dispensateurs de soins complets étaient susceptibles de traiter un CDI qui utilise des services d’échange de seringues sur une base régulière. La majorité des dispensateurs de soins complets (n=86 [89,58 %]) étaient susceptibles de traiter un ancien CDI stabilisé par un traitement de substitution. D’après l’analyse bivariée, les facteurs associés à la probabilité de dispenser un traitement aux CDI incluaient le type de médecin, c’est-à-dire les spécialistes en infectiologie par rapport aux autres spécialistes (RRR 3,27 [95 % IC 1,11 à 9,63]) et la dimension de la collectivité où ils exercent (RRR 4,16 [95 % IC 1,36 à 12,71] [population de 500 000 habitants ou plus par rapport à population de moins de 500 000 habitants]). Les résultats de l’analyse de régression logistique multivariée étaient largement conformes à ceux observés dans les analyses bivariées. Après contrôle des autres variables confusionnelles, seule la dimension de la collectivité avait un lien significatif avec l’administration d’un traitement aux CDI (RRR 3,89 [95 % IC 1,06 à 14,26] [population de 500 000 habitants ou plus par rapport à population de moins de 500 000 habitants]).
CONCLUSION :: La présente étude a fait ressortir l’hésitation à dispenser un traitement aux CDI infectés par le VHC. Il est difficile d’offrir des services thérapeutiques aux consommateurs de drogues infectés par le VIH, et on constate beaucoup d’obstacles au traitement. Cependant, la prestation efficace du traitement à cette population contribuera à limiter la propagation du VHC. La présente étude a clairement établi la nécessité d’améliorer l’accessibilité au traitement du VHC pour les CDI.
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