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Provider‐related barriers and enablers to the provision of hepatitis C treatment by General Practitioners in Scotland: A behaviour change analysis

Whiteley, David; Speakman, Elizabeth; Elliott, Lawrie; Davidson, Katherine; Hamilton, Emma; Jarvis, Helen; Quinn, Michael; Flowers, Paul


David Whiteley

Elizabeth Speakman

Lawrie Elliott

Katherine Davidson

Emma Hamilton

Helen Jarvis

Michael Quinn

Paul Flowers


The ease of Direct Acting Antiviral (DAA) medications for hepatitis C virus (HCV) has provided an opportunity to decentralise HCV treatment into community settings. However, the role of non-specialist clinicians in community-based pathways has received scant attention to date. This study examined barriers and enablers to expanding the role of General Practitioners (GPs) in HCV treatment provision, using simple behaviour change theory as a conceptual framework. A maximum variation sample of 22 HCV treatment providers, GPs and HCV support workers participated in semi-structured interviews. Data were inductively coded, and the resulting codes deductively mapped into three principal components of behaviour change: capability, opportunity, and motivation (COM-B). By this process, a number of provider- and systemic-level barriers and enablers were identified. Key barriers included the pre-treatment assessment of liver fibrosis, GP capacity and the ‘speciality’ of HCV care. Enablers included the simplicity of the drugs, existing GP/patient relationships, and the provision of holistic care. In addition to these specific factors, the data also exposed an overarching provider understanding of ‘HCV treatment’ as triumvirate in nature, incorporating the assessment of liver fibrosis, the provision of holistic support, and the treatment of disease. This understanding imposes a further fundamental barrier to GP-led treatment as each of these three components need to be individually addressed. To enable sustainable models of HCV treatment provision by GPs, a pragmatic re-examination of the ‘HCV treatment triumvirate’ is required, and a paradigm shift from the ‘refer and treat’ status quo.

Journal Article Type Article
Acceptance Date Nov 8, 2020
Online Publication Date Nov 20, 2020
Publication Date 2021-03
Deposit Date Nov 9, 2020
Publicly Available Date Nov 21, 2021
Journal Journal of Viral Hepatitis
Print ISSN 1352-0504
Electronic ISSN 1365-2893
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 28
Issue 3
Pages 528-537
Keywords Hepatitis C; General Practitioners; Therapeutics
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Provider-related Barriers And Enablers To The Provision Of Hepatitis C Treatment By General Practitioners In Scotland: A Behaviour Change Analysis (619 Kb)

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Copyright Statement
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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