Developing a primary care-initiated hepatitis C treatment pathway in Scotland: a qualitative study

TY - JOUR

T1 - Developing a primary care-initiated hepatitis C treatment pathway in Scotland

T2 - a qualitative study

AU - Whiteley, David

AU - Speakman, Elizabeth M.

AU - Elliott, Lawrie

AU - Jarvis, Helen

AU - Davidson, Katherine

AU - Quinn, Michael

AU - Flowers, Paul

N1 - Funding Information: This study was funded in full by the Chief Scientist Office of the Scottish Government Health Directorates (reference: HIPS/18/49). Publisher Copyright: © The Authors 2022.

PY - 2022/9

Y1 - 2022/9

N2 - Background: The ease of contemporary hepatitis C virus (HCV) therapy has prompted a global drive towards simplified and decentralised treatment pathways. In some countries, primary care has become an integral component of community-based HCV treatment provision. In the UK, however, the role of primary care providers remains largely focused on testing and diagnosis alone.Aim: To develop a primary care-initiated HCV treatment pathway for people who use drugs, and recommend theory-informed interventions to help embed that pathway into practice. Design and setting A qualitative study informed by behaviour change theory. Semi-structured interviews were undertaken with key stakeholders (n = 38) primarily from two large conurbations in Scotland.Method: Analysis was three-stage. First, a broad pathway structure was outlined and then sequential pathway steps were specified; second, thematic data were aligned to pathway steps, and significant barriers and enablers were identified; and, third, the Theoretical Domains Framework and Behaviour Change Wheel were employed to systematically develop ideas to enhance pathway implementation, which stakeholders then appraised.Results: The proposed pathway structure spans broad, overarching challenges to primary care-initiated HCV treatment. The theory-informed recommendations align with influences on different behaviours at key pathway steps, and focus on relationship building, routinisation, education, combating stigmas, publicising the pathway, and treatment protocol development.Conclusion: This study provides the first practicable pathway for primary care-initiated HCV treatment in Scotland, and provides recommendations for wider implementation in the UK. It positions primary care providers as an integral part of community-based HCV treatment, providing workable solutions to ingrained barriers to care.

AB - Background: The ease of contemporary hepatitis C virus (HCV) therapy has prompted a global drive towards simplified and decentralised treatment pathways. In some countries, primary care has become an integral component of community-based HCV treatment provision. In the UK, however, the role of primary care providers remains largely focused on testing and diagnosis alone.Aim: To develop a primary care-initiated HCV treatment pathway for people who use drugs, and recommend theory-informed interventions to help embed that pathway into practice. Design and setting A qualitative study informed by behaviour change theory. Semi-structured interviews were undertaken with key stakeholders (n = 38) primarily from two large conurbations in Scotland.Method: Analysis was three-stage. First, a broad pathway structure was outlined and then sequential pathway steps were specified; second, thematic data were aligned to pathway steps, and significant barriers and enablers were identified; and, third, the Theoretical Domains Framework and Behaviour Change Wheel were employed to systematically develop ideas to enhance pathway implementation, which stakeholders then appraised.Results: The proposed pathway structure spans broad, overarching challenges to primary care-initiated HCV treatment. The theory-informed recommendations align with influences on different behaviours at key pathway steps, and focus on relationship building, routinisation, education, combating stigmas, publicising the pathway, and treatment protocol development.Conclusion: This study provides the first practicable pathway for primary care-initiated HCV treatment in Scotland, and provides recommendations for wider implementation in the UK. It positions primary care providers as an integral part of community-based HCV treatment, providing workable solutions to ingrained barriers to care.

KW - general practice

KW - hepatitis C

KW - primary health care

KW - qualitative research

KW - Scotland

KW - therapeutics

UR - https://www.scopus.com/pages/publications/85133892639

U2 - 10.3399/BJGP.2022.0044

DO - 10.3399/BJGP.2022.0044

M3 - Article

C2 - 35606160

AN - SCOPUS:85133892639

SN - 0960-1643

VL - 72

SP - E668-E676

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 722

ER -