Physicians' attitudes and practice toward treating injection drug users infected with hepatitis C virus: Results from a national specialist survey in Canada
Physicians' attitudes and practice toward treating injection drug users infected with hepatitis C virus: Results from a national specialist survey in Canada
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DOI：
10.1155/2011/810108
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发表时间：
2011-03-01
影响因子：
2.7
通讯作者：
Wang, Peizhong Peter
中科院分区：
文献类型：
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作者：
Myles, Angelique;Mugford, Gerry J.;Wang, Peizhong Peter
背景技术背景：在加拿大，每年超过70%的丙型肝炎病毒（HCV）感染新病例涉及注射吸毒者（IDUs），目前，关于如何为他们提供医疗保健还没有达成共识。目的：要检查加拿大专科医生的特点和他们的可能性提供治疗HCV患者谁是IDUs.METHODS：一个全国性的，横断面研究进行了肝病，胃肠病学和传染病的专业领域，检查HCV服务。调查问卷要求提供有关基本人口统计学、转诊途径和意见（是/否）的信息，并检查医生的治疗方案如何受到治疗资格、HCV护理管理和提供优质服务的障碍等因素的影响。尽管事实上大多数HCV流行和偶发病例与注射毒品有关，很少有专科医生实际上为这一群体提供必要的治疗。只有19个（19.79%）综合服务提供者可能为目前定期使用针具交换的注射吸毒者提供治疗。大多数综合服务提供者（n=86 [89.58%]）可能会为在替代疗法中稳定的前IDU提供治疗。在双变量分析中，与向目前的注射吸毒者提供治疗的可能性相关的因素包括医生的类型，即传染病专家与非传染病专家的比较（OR 3.27 [95% CI 1.11 - 9.63]），以及他们执业的社区规模（OR 4.16 [95% CI 1.36 - 12.71] [≥ 500，000人vs <500，000人]）。多变量logistic回归分析的结果与双变量分析中观察到的结果基本一致。在控制了其他混杂变量后，只有社区规模与向当前注射吸毒者提供治疗显著相关（OR 3.89 [95%CI 1.06至14.26] [人口500，000或更大与小于500，000]）。结论：本研究强调了专科医生不愿意向当前感染HCV的注射吸毒者提供治疗。为HCV感染的药物滥用者提供治疗服务具有挑战性，存在许多治疗障碍。然而，对这一人群的有效治疗将有助于限制HCV的传播。本研究明确指出，需要改善注射吸毒者获得HCV治疗的机会。
BACKGROUND: In Canada, more than 70% of new cases of hepatitis C virus (HCV) infection per year involve injection drug users (IDUs) and, currently, there is no consensus on how to offer them medical care. OBJECTIVE: To examine the characteristics of Canadian specialist physicians and their likelihood to provide treatment to HCV patients who are IDUs.METHODS: A nationwide, cross-sectional study was conducted in the specialty areas of hepatology, gastroenterology and infectious diseases to examine HCV services. The questionnaire requested information regarding basic demographics, referral pathways and opinions (yes/no), and examined how a physician's treatment regimen is influenced by factors such as treatment eligibility, HCV care management and barriers to providing quality service.Results: Despite the fact that the majority of prevalent and incident cases of HCV are associated with injection drug use, very few specialist physicians actually provide the necessary therapy to this population. Only 19 (19.79%) comprehensive service providers were likely to provide treatment to a current IDU who uses a needle exchange on a regular basis. The majority of comprehensive service providers (n=86 [89.58%]) were likely to provide treatment to a former IDU who was stable on substitution therapy. On bivariate analysis, factors associated with the likelihood to provide treatment to current IDUs included physicians' type, ie, infectious disease specialists compared with noninfectious specialists (OR 3.27 [95% CI 1.11 to 9.63]), and the size of the community where they practice (OR 4.16 [95% CI 1.36 to 12.71] [population 500,000 or greater versus less than 500,000]). Results of the multivariate logistic regression analysis were largely consistent with the results observed in the bivariate analyses. After controlling for other confounding variables, only community size was significantly associated with providing treatment to current IDUs (OR 3.89 [95% CI 1.06 to 14.26] [population 500,000 or greater versus less than 500,000]).CONCLUSION: The present study highlighted the reluctance of specialists to provide treatment to current IDUs infected with HCV. Providing treatment services for HCV-infected substance abusers is challenging and there are many treatment barriers. However, effective delivery of treatment to this population will help to limit the spread of HCV. The present study clearly identified a need for improved HCV treatment accessibility for IDUs.