The role of the general practitioner in the screening and clinical management of chronic viral hepatitis in six EU countries


chronic viral hepatitis
clinical management
general practitioner
primary care


Introduction Chronic viral hepatitis is still a major public health concern in the EU. In order to halt the progression of the disease and to prevent onward transmission, timely recognition and accurate clinical management are crucial. The aim of the present study was to investigate the role of the general practitioner (GP) in the screening of persons at risk and in the clinical management of chronic viral hepatitis patients in six EU countries.

Methods An online survey among GPs and secondary care specialists was conducted in the UK, Germany, the Netherlands, Hungary, Italy, and Spain. In the GP survey we aimed to find out how commonly risk groups are screened, using a four-point Likert scale. In both surveys, we measured whether GPs are involved in monitoring clinical indicators in patients undergoing antiviral treatment and explored whether patients in four clinical scenarios are referred back to primary care.

Results Between five and 10 experts per professional group were reached except for Spain (GPs: n=2; Specialists: n=4) and, in the case of the GP survey, Hungary (GPs: n=4) and Germany (GPs: n=4). Migrants are variably or not routinely screened for Hepatitis B/C in the majority of cases. The majority of GPs reported that hepatitis B/C screening is routinely offered to people who inject drugs. In Hungary, Italy and in the Netherlands screening sex workers is not regularly practiced. As to whether GPs offer screening to men having sex with men, responses varied between variably and commonly practiced in Germany, the Netherlands and Italy, while in Hungary the practice seems to be sporadic; in the UK, while screening for hepatitis B seems to be common practice among GPs, hepatitis C testing is only occasionally offered to this risk group. Most GPs (>44%) in all countries except in Hungary reported that it is very common practice to offer hepatitis B/C screening to HIV patients.

The role of the GPs in monitoring hepatitis cases and the referral of cases back to the GPs varied within and between countries. GPs are unlikely to monitor clinical outcomes other than side effects in patients undergoing treatment. Patients who have had a sustained virological response are usually referred back to GPs, whereas patients who do not respond to treatment are rarely referred back to primary care.

Discussion The GPs decision to offer screening to risk groups often seems to be an individually motivated choice of the health care professional. Raising awareness among GPs about the disease, for example through the adoption of effective strategies for the dissemination and implementation of the existing guidelines for general practice, is highly needed. The role of GPs and specialists involved in the management of chronically infected patients should also be clarified, as the professionals opinion sometimes differed markedly even within the two professional groups.


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