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RACGP backs vision for national hepatitis strategies


Morgan Liotta


11/07/2023 4:19:26 PM

The college has put forward recommendations to strengthen the draft 2023–30 strategies and ensure targets are met.

Hepatitis virus
The national strategies will drive responses to achieve the target of eliminating hepatitis B and C as public health threats by 2030.

It is ‘critical’ people have equal access to safe and affordable testing, management and treatment of hepatitis B and C.
 
This a key recommendation from the RACGP’s response to the Department of Health and Aged Care (DoH) draft Fourth National Hepatitis B Strategy 2023–30 and Sixth National Hepatitis C Strategy 2023–30.
 
The RACGP supports the vision statements for both strategies, which outline Australia’s response to eliminating hepatitis B and C as public health threats by 2030, and promotes ‘equitable access to safe, affordable and effective vaccines, prevention, education, testing, management and treatment, including appropriate person-centred care and support’.
 
While supporting the strategies’ priority areas for action of testing, treatment and management, the college also emphasises the importance of GPs’ role, and recommends ongoing promotion and support for coordinated patient care and training requirements for GPs.
 
‘Testing, monitoring, management and treatment for hepatitis B and C is part of core work for GPs,’ RACGP President Dr Nicole Higgins wrote in the submission.
 
‘GPs often initiate testing, play a key role in raising awareness of infection and reinfection, and in implementing primary and secondary prevention measures.
 
‘The holistic, patient-centred, and relationship-based approach of general practice can ensure the effective delivery of preventive care and treatment.’
 
Dr Higgins also recommended that each strategy have a stronger focus on hard-to-reach populations, as hepatitis B and C often impact people who are already marginalised, and may have significant health and social needs such as mental health issues, poor access to stable housing and transport and comorbid diseases.
 
‘Increasing access to treatment will require specific planning for how this will occur,’ Dr Higgins wrote.
 
‘Promoting and supporting general practice care for patients living with hepatitis C is essential. Siloed services run the risk of further fragmenting care. These patients require holistic care such as that provided by general practice.’
 
The college likewise recommends further and ongoing support for GP-led shared care, including access to non-GP specialists as needed, stating that coordinated care between all services ‘is essential to provide timely and effective care’ for patients living with hepatitis B and C.
 
‘We agree that general practice should be supported to have partnerships with public health units and with other organisations involved in ongoing care of patients,’ Dr Higgins wrote.
 
‘A shared care model supporting shared care pathways, where GPs and non-GP specialists work in concert to improve care for people with complex chronic conditions should be established and embedded in practice to improve care.’
 
Further, the college provided recommendations around prescribing hepatitis antiviral treatments, including streamlining training for GPs to improve delivery of care.
 
Medications for hepatitis B and C treatment are classified as S100 ‘highly specialised drugs’, under the National Health Act, and GPs need to undergo further training to be able to prescribe these medications.
 
‘As expert generalists, GPs are professionals who work within their scope of practice and seek relevant education to gain the knowledge and skills they need to serve the needs of their patient populations,’ Dr Higgins wrote.
 
‘[But] this additional training requirement can be a barrier to the delivery of care. In the case of hepatitis C, this may also result in a considerable underuse of curative medications for the disease.’
 
The RACGP is calling for the removal of additional training requirements that GPs currently need to undertake to provide antiviral medications, provided GPs still have access to clinical practice guidelines and the online health information portal, HealthPathways, which contains ‘locally relevant pathways to clinicians to help facilitate safe and effective prescribing.’
 
While the hepatitis treatments are ‘an effective means of overcoming barriers for patients to access these medications’, the RACGP proposes additional prescribing recommendations, including:
 

  • changing the Authority to a ‘Streamlined Authority’ to remove some time constraints on prescribing without removing the criteria required to prescribe
  • that non-GP prescribers of antivirals should be required to communicate the treatment plan and other relevant details to the person’s regular GP, to ensure the patient receives holistic care before, during and after antiviral treatment.
                                                                                                                                 
The DoH’s draft eight-year strategies are intended to drive public health responses to achieve elimination targets, with the vision that by 2030, people living with hepatitis B and/or C will be ‘active decision makers in their care, live free from stigma, discrimination, and racism and lead healthy and productive lives’.
 
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