Background

The new direct-acting antivirals (DAAs) to treat hepatitis C are a huge improvement on the previous generation of Hep C drugs. They are generally very well tolerated, have a treatment time frame of only 8-12 weeks and deliver a 90-98% cure rate.

General practitioners (GPs), in consultation with a specialist, can prescribe these medications (authority script), providing a once in a generation opportunity to reduce transmission, prevent reinfection and eradicate hepatitis C.

More than 74,200 Victorians currently live with hepatitis C. Because a majority of HCV infections progress to chronicity, so long as the incidence of new infections substantially out paces the rate of treatment with cure, the prevalence of chronic HCV infection in Australia will continue to rise.

Australia wide, chronic Hepatitis C results in up to 630 deaths from liver cancer and liver failure each year.

Currently treatment for HCV infection is mainly delivered through private specialist providers and hospitals based liver clinics. These services cannot possibly hope to meet the demand posed by the numbers of infected Australians.

Between March 2016 and June 2016, about 12% of individuals in Victoria living with chronic Hepatitis C have initiated treatment2.

Education and Training Opportunities

NPS Medicine Wise Learning: Online Module
This module will provide you with training in the diagnosis, treatment and ongoing management of people with chronic hepatitis C infection. Hepatitis C (HCV) remains a significant public health issue in Australia and GPs are an essential part of the management team, from identifying people who may be at risk of infection to diagnosis and monitoring of liver disease. In addition, with the new direct-acting antiviral (DAA) agents now available on the PBS general schedule it is even more vital that GPs are aware of HCV treatment strategies.

Hepatitis Victoria: HepReady Training Calendar
The HEPReady training courses will give your workforce the edge with the must-know clinical aspects of viral hepatitis. But the key point of difference with HEPReady is its significant focus on the lived experience of a person with hepatitis, and the stigma and discrimination they encounter.

In addition to the Essentials stream, this year they have introduced a series of new comprehensive mini-courses, that allow participants to self-select one or a combination of topics, depending on their areas of interest. By selecting four courses plus a 3-hour practical session, you will be eligible for a Comprehensive Certificate.

Email or call 9380 4644 for a free assessment of your training needs or with any questions.

Victorian Primary Health Network Alliance: Online Module
The ‘Curing hepatitis C - Your role as a GP’ online education module is designed to educate GPs on how to assess patients with hepatitis C prior to initiating treatment and assist with the selection of an appropriate direct-acting antiviral (DAA) agent. This module was created by North Western Melbourne PHN.

Resources for General Practice

Western Victoria PHN HealthPathways: The Hep C page on Western Victoria PHN HealthPathways provides relevant clinical information on all aspects of the treatment process.

For the HealthPathways username and password, email healthpathways@westvicphn.com.au

Recent changes (1 Oct 2016) to the PBS for GP Prescribing of Hepatitis C Medications

Templates

Please note that opening these templates outside medical software may corrupt the coded fields. Import into your medical software prior to opening

Patient Recall Letter Best Practice Medical Director Zedmed
Care Plan Template Best Practice Medical Director Zedmed

Barwon Health Remote Consultation Referral Template (Best Practice, Medical Director and Zedmed)

Practice Nurse Care Plan Checklist

Medical Software Cheat Sheets

Searching Your Database Best Practice Medical Director Zedmed

Website Resources for GPs

Fact Sheet for Community Based Prescriber
Hep C Help: Helping GPs navigate hep C Care website
PBS General Statement for Drugs for the Treatment of Hepatitis C. Outlines patient eligibility criteria for PBS subsided direct-acting antivirals for the treatment of hepatitis C.
Free Vaccines Schedule for Vulnerable Citizens: The Hepatitis B vaccination is available free to people diagnosed with hepatitis C under the National Immunisation Program.

Pre-prescription Web Based Assessment Tools for GPs

  • AST to Platelet Ratio Index (APRI) Calculator - This tool calculates a patient’s AST to Platelet Ratio Index. The APRI score is a screening tool for liver fibrosis, not a diagnostic test.
  • Drug Interactions - Checks for drug interactions between drugs used to treat hepatitis C and those used for other conditions.

Clinical Guidelines for GPs

  • A summary of clinical guidance for treating patients with hepatitis C. The guidelines include a checklist for pre-treatment assessment of people with hepatitis C.
  • Australian Recommendations for the Management of Hepatitis C Virus Infections: A Consensus Statement 2016. Detailed guidelines providing recommendations for hepatitis C treatment and management.

Local Support for GPs

Barwon Health Liver Clinic:
For advice on patient management, or suitability for referral, phone hepatology clinical nurse consultant on 4215 1501

Phone the Outpatient GP Hotline on 4215 1398 (general practitioner use only) to:

  • Discuss the triage of your patient, or for additional information about referral.
  • Enquire about the liver clinic

Refer to the Barwon Health Liver Clinic send via:

  • ReferralNet, or
  • Fax 4215 1383

GP Peer Advice:
GPs in the Geelong Otway region can call and speak with Dr Mark Davies, GP at Lara Medical Centre and Barwon Health Drug and Alcohol Services. For Mark's contact details, call Tracey Roebuck or Margaret Dempsey at Western Victoria PHN on 5222 0800.

Ballarat Health Services Liver Clinic:
For advice on patient management, or suitability for referral, phone the Ballarat Health Services Liver Clinic on  5320 4211

Refer to the Ballarat Health Services Liver Clinic:

  • Refer to Dr Mohammed Al-Ansari, Gastroenterologist
  • Fax  5320 4472

NB: Patients with liver cirrhosis should be referred to specialist services. Patients without cirrhosis can be managed by their GP.

Resources for Pharmacy

Fact Sheet for Community Based Dispensers
PBS General Statement for Drugs for the Treatment of Hepatitis C. Outlines patient eligibility criteria for PBS subsidised direct-acting antivirals for the treatment of hepatitis C.
Pharmaceutical Society of Australia - Presentation 1
Pharmaceutical Society of Australia - Presentation 2
Pharmaceutical Society of Australia Webinar

Web based resources for patients

General and treatment information for people living with hepatitis C.

Western Victoria PHN Support Team

If you would like information on any aspect of the Hep C clinical pathway, or help searching your database for your Hep C patients and sourcing patient education resources, please contact:
Geelong Otway: Tracey Roebuck (Mon- Wed) or P: 5222 0800
Wimmera Grampians: Krista Fischer (Mon- Fri) and Clair McDonald (Mon, Wed, Thurs) or P: 5381 1756
Ballarat GoldfieldsJacqui White (Mon- Fri) or P: 5304 5605
Great South CoastRaj Samrai (Mon- Fri) or P: 5564 5827