As Hepatitis C was not a disease before 1990, any doctors were not taught about it in Medical School before 1990.
GP's need to keep updated on a huge variety of conditions. Most never see a HepC patient and have little interest in liver disease in general. My GP is a great guy who is very experienced in his field. However he can't even feel a slightly enlarged spleen, knows nothing about cirrhosis, and has no interest in the new HepC treatments coming on line.
GI Specialists are mostly interested in performing procedures like endoscopy and ERCP. I know one GI guy who does 10 sessions of these per week, averaging 10 patients per session at ~$1,000 per patient. Hepatology requires patient contact at $300-500 per visit.
Hepatologists usually are part-time academics who are not worried about money. These are the guys that attend Meetings and keep up to date.
IMHO, every new patient should be initially seen by a Hepatologist and appropriately assessed. Once treatment is decided and prescribed, followup can be left to GP's, NP's or whatever.
Otherwise, too many cirrhotics would fall through the cracks, never be diagnosed, then suddenly present with a HCC down the line. Also, inappropriate treatment lengths may result in more relapses and eventually the virus will figure out how to become resistant to Sovaldi.
Rubye, your prescription may have been given to you by a NP, but a Specialist would have assessed your results and written the script.
Nobody expects all patients to be treated immediately. Some prioritisation is to be expected, and this can only be done by specialised people. Country patients should be expected to travel to a regional centre for this first visit.
Australia has about 400,000 patients with HepC. It is estimated that about half have been diagnosed, but only about 20% have been treated. Of these, only about 50% have achieved SVR. Educating GP's about the need for HepC testing is the priority. This is slowly being done, but the USA and Europe are far behind.
sirronalot said
May 25, 2015
I would think the price and availability would have to change drastically before a GP could prescribe the stuff. With my experience all GP's are good for is righting scripts for antibiotics without doing a culture, referring you to a specialist and try to sell you the pyramid scams of supplements. They shouldn't be called GP's. They should be called RP's (Referring Physician). I haven't had a GP in years. I just bypass them and go directly to the specialist.This could be a generalization and there still may be some good ones out there but I think anybody on this form could be there own GP (My Thought). I remember when I was kid I broke my arm I went to the GP they put a cast on it and sent me on my way. Break your arm now and go to a GP. You will wind up seeing three different specialist.
If the price and availability were there. I'm all for any MD professional to prescribe. We do need to Slay the Dragon!
My thoughts Only,
Thanks Ron
Fireman Rob said
May 25, 2015
My GI was nothing short of laughable. Let's just say I'm glad I did my own research. My GP is much better equiped than the "specialist". Bring it on!
-Rob
Brian1412 said
May 25, 2015
One more thought
fourlocos said
May 25, 2015
In my own case I would have preferred my primary care doctor treating me. She openly admits that she knows nothing about Harvoni or treatments. She referred me after diagnosing me to the specialist who only saw me for 10 minutes. I have spoke to him on the phone twice but never was asked to come in again. I find that odd and I never felt like he really cared about ME. If they educate the primary doctors it might not be the worst thing. She at least cares and takes time to listen to me.
Brian1412 said
May 25, 2015
Welcome to walgreens! Be well. Would you like to buy candy. 2For 1 today? Do you have your walgreen card? Whats your phone number? e having a special. On hep c medication... didn't. They slready try this in that healthcare. Thingy called o care.. ? we have a massive. Shortage of drs here .
The place i go to to get treated is something like this. I first had to go go to a clinic which is run by :the. 8th. Largest. Healthcare. System. On the usa, and yes they tout that.bigger is not best.my primary. Is a nice np and. If you need lets say ptotonics. You can count on about. 6_8 weeks to get. It. The reason it takes so long is whst they call. Touches. Touches is how they get their funding from o care. So it is in their interests. To make you come often and it is all day affair. If you push hard enough.you get sent to outpatients. Clicinc where you can see a liver specialists. Rember:i had 2 liver speaislist who never typed me.snd never did any tests and misees 51out of 52 scheduled appointments? It took me a year. To get current dr and the med and as good as he is. I still have to consistently push to actuslly get things done and to do thst i have yo go thru yhe original clinic...it is a bunch of layers that are solely in place for getting the touches. To grt more funding.
Mal is right.. resistance. You know they are going to find the essiest and cheaper way to treat in these clinics. Only one of these. I have seen one of these work would be cleveland clinic and it works because all the medical staff are. Volunteers and ecperts in the they treat
Gracie said
May 25, 2015
I actually only saw my doc once before incevik and haven't seen him since. I dealt with his hep nurse about everything from the instruction visit through all the side effects etc. Maybe the care will actually be better if they did it here as we have a shortage of doctors.
Rubye said
May 25, 2015
My prescription for Sovaldi and Olysio was given to me by a nurse practitioner back in October. I see no problem with it and think it is a good thing, especially since I couldn't find a doctor who would let me treat.
Gracie said
May 24, 2015
Hopefully they will require fibroscans and follow the suggested protocol regarding previously treated, non responders etc. If the protocols are clear, it may make the wait times less for those wanting to treat.
Someday we will probably see people going to the doctor and getting a prescription which they fill out and take themselves as it becomes more curable and easily tolerated.
mallani said
May 24, 2015
My problem with this is: who decides on treatment duration, and pre-treatment assessment of liver status. Most GP's don't have a clue.
Cost will be an issue and I can just see patients being put on 8 weeks with an increase in the number of relapses.
Although it's not as issue as yet, there is a risk of building up a population of virus resistant to Sovaldi.
Gracie said
May 24, 2015
Found this interesting. Must be because harvoni is so well tolerated ... The times, they are a changin'
A new study led by the U.S. National Institutes of Health will evaluate whether primary care doctors and other health care providers such as nurse practitioners can provide interferon-free therapy for hepatitis C as effectively as hepatologists or infectious disease specialists. This model of community-based care could expand the number of people able to access hepatitis C treatment.
The study, called ASCEND, plans to enroll 600 participants at 12 clinics in Washington, DC. The participants, who will be living with hepatitis C or Hep C and HIV co-infection, will receive Harvoni (ledipasvir + sofosbuvir) for eight to 24 weeks. (HIVandhepatitis.com, April 2015, in English)
As Hepatitis C was not a disease before 1990, any doctors were not taught about it in Medical School before 1990.
GP's need to keep updated on a huge variety of conditions. Most never see a HepC patient and have little interest in liver disease in general. My GP is a great guy who is very experienced in his field. However he can't even feel a slightly enlarged spleen, knows nothing about cirrhosis, and has no interest in the new HepC treatments coming on line.
GI Specialists are mostly interested in performing procedures like endoscopy and ERCP. I know one GI guy who does 10 sessions of these per week, averaging 10 patients per session at ~$1,000 per patient. Hepatology requires patient contact at $300-500 per visit.
Hepatologists usually are part-time academics who are not worried about money. These are the guys that attend Meetings and keep up to date.
IMHO, every new patient should be initially seen by a Hepatologist and appropriately assessed. Once treatment is decided and prescribed, followup can be left to GP's, NP's or whatever.
Otherwise, too many cirrhotics would fall through the cracks, never be diagnosed, then suddenly present with a HCC down the line. Also, inappropriate treatment lengths may result in more relapses and eventually the virus will figure out how to become resistant to Sovaldi.
Rubye, your prescription may have been given to you by a NP, but a Specialist would have assessed your results and written the script.
Nobody expects all patients to be treated immediately. Some prioritisation is to be expected, and this can only be done by specialised people. Country patients should be expected to travel to a regional centre for this first visit.
Australia has about 400,000 patients with HepC. It is estimated that about half have been diagnosed, but only about 20% have been treated. Of these, only about 50% have achieved SVR. Educating GP's about the need for HepC testing is the priority. This is slowly being done, but the USA and Europe are far behind.
I would think the price and availability would have to change drastically before a GP could prescribe the stuff. With my experience all GP's are good for is righting scripts for antibiotics without doing a culture, referring you to a specialist and try to sell you the pyramid scams of supplements. They shouldn't be called GP's. They should be called RP's (Referring Physician). I haven't had a GP in years. I just bypass them and go directly to the specialist.This could be a generalization and there still may be some good ones out there but I think anybody on this form could be there own GP (My Thought). I remember when I was kid I broke my arm I went to the GP they put a cast on it and sent me on my way. Break your arm now and go to a GP. You will wind up seeing three different specialist.
If the price and availability were there. I'm all for any MD professional to prescribe. We do need to Slay the Dragon!
My thoughts Only,
Thanks Ron
My GI was nothing short of laughable. Let's just say I'm glad I did my own research. My GP is much better equiped than the "specialist". Bring it on!
-Rob
In my own case I would have preferred my primary care doctor treating me. She openly admits that she knows nothing about Harvoni or treatments. She referred me after diagnosing me to the specialist who only saw me for 10 minutes. I have spoke to him on the phone twice but never was asked to come in again. I find that odd and I never felt like he really cared about ME. If they educate the primary doctors it might not be the worst thing. She at least cares and takes time to listen to me.
I actually only saw my doc once before incevik and haven't seen him since. I dealt with his hep nurse about everything from the instruction visit through all the side effects etc. Maybe the care will actually be better if they did it here as we have a shortage of doctors.
My prescription for Sovaldi and Olysio was given to me by a nurse practitioner back in October. I see no problem with it and think it is a good thing, especially since I couldn't find a doctor who would let me treat.
Hopefully they will require fibroscans and follow the suggested protocol regarding previously treated, non responders etc. If the protocols are clear, it may make the wait times less for those wanting to treat.
Someday we will probably see people going to the doctor and getting a prescription which they fill out and take themselves as it becomes more curable and easily tolerated.
My problem with this is: who decides on treatment duration, and pre-treatment assessment of liver status. Most GP's don't have a clue.
Cost will be an issue and I can just see patients being put on 8 weeks with an increase in the number of relapses.
Although it's not as issue as yet, there is a risk of building up a population of virus resistant to Sovaldi.
Found this interesting. Must be because harvoni is so well tolerated ... The times, they are a changin'
New study to examine the effectiveness of community-based hepatitis C treatment
A new study led by the U.S. National Institutes of Health will evaluate whether primary care doctors and other health care providers such as nurse practitioners can provide interferon-free therapy for hepatitis C as effectively as hepatologists or infectious disease specialists. This model of community-based care could expand the number of people able to access hepatitis C treatment.
The study, called ASCEND, plans to enroll 600 participants at 12 clinics in Washington, DC. The participants, who will be living with hepatitis C or Hep C and HIV co-infection, will receive Harvoni (ledipasvir + sofosbuvir) for eight to 24 weeks. (HIVandhepatitis.com, April 2015, in English)