Theme: Models of Care Year: 2018
Background:
Medeco-Inala is a six doctor General Practice in a low socio-economic area, encountering
many social problems especially substance abuse with 234 patients enrolled in Opioid
Substitution Treatment (OST). Inala has the highest rate of Hepatitis C by post code in
Australia. We aimed to “think national, act local” by micro-elimination of Hepatitis C in primary
care.
Approach:
Screening 40 Hepatitis C patients, the vast majority preferred treatment through their General
Practitioner (GP). Key factors cited included: costs (private specialists, transport and parking
at hospitals), judgemental attitudes encountered in hospitals, familiarity and trust with GPs
and staff, geographic and parking convenience and less delay.
In 2016 our team undertook to eradicate Hep C from our Practice using a committed team
approach. Defining goals and motivations for the project to all team members ensured solid
commitment from receptionists, managers, nurses and doctors.
Publicizing the project required waiting room posters advertising new cures available for
Hepatitis C. Patients were encouraged to make enquiries with their GP.
GPs were upskilled regarding risk factors, screening, new pharmaceutical regimes and prerequisite investigations.
For patients with AST to Platelet Ratio Index scores over 1.0, we further investigated for
cirrhosis with a fibro-scanner that visits our suburb monthly.
Patients are encouraged to “bring a friend” for testing and to help, “spread the cure not the
disease”.
Outcome:
Of our Practice’s 234 OST patients, 234 have been screened, 176 diagnosed, 38 resolved
infections spontaneously, 151 started treatment, and 148 cured. This translates into 45 cases
of cirrhosis and 9 hepato-cellular carcinomas prevented.
Conclusion:
Our study shows the primary care setting is ideal for eliminating Hepatitis C. Educating GPs
and staff members ensures all parties buy into the project. Waiting room advertising, proactive screening and encouraging patients to “bring a friend” are valuable elements. Our model
is readily reproducible in all General Practices.
Disclosure of Interest Statement:
No external sources of income have been received to fund the Medeco-Inala project.