TOPIC:

I thought the PBAC recommendations were that the DAA's wouldn't come under the s100 scheme? Did something change?

So does that mean we are going to have to wait for our GPs to do this course before they can prescribe our DAAs?
This could drag things out considerably!

klhilde wrote: More than anyone else, it's the accountants that are pushing for the shorter treatments. With the price of generics that is much less necessary.

Read the trial results for yourself, or read what Dr. Freeman himself has said on the subject in this forum. There are quite a number of incredibly well informed people here ... we've been reading for ourselves rather than cowering before authority.

I can tell you this for a fact: Four and three months ago respectively, neither my GI doctor in the US nor my GI doctor in Thailand were aware of the differences in treatment recommendations between the US establishment and the EU establishment. I told my specialists what was going on, not the other way around.

Things are different in Australia. Our Government pays per cure regardless of the length of treatment so what the accountants say makes little difference. I don't know how the US or Thailand develop their treatment guidelines, but in Australia, they are comprehensive, evidence based and published for every doctor to use.

flyingfox66 wrote: So does that mean we are going to have to wait for our GPs to do this course before they can prescribe our DAAs?
This could drag things out considerably!

Go to the liver clinic

zhuk wrote: I thought the PBAC recommendations were that the DAA's wouldn't come under the s100 scheme? Did something change?

Sorry, its a naming issue. The recommendation is for s85 but we've always referred to the doctors as "s100 prescribers". We might have to say "hep C prescribers" instead. But you raise a good point, this needs some clarification.

Doctors generally follow protocol. The bureaucracy creates the protocol. The accountants are definitely a part of the bureaucracy that establishes the protocol.

Always.

I have got my ass covered with a specialist appt on March 10. But if this is true it contradicts what people are being told over at the Facebook page. Thousands of GPs to choose from, just roll up roll up. Could be some disappointed hepsters...

Seymour Wrote
"Treatment guidelines provide indisputable evidence based recommendations on which medication is suitable for patients depending on genotype, fibrosis, treatment history, comorbidity,"

"indisputable evidence"??
You have to be kidding Seymour.Ever taken a close look at the figures that make up these tx guidlines?Ever had to educate your GP where to look and how to interpret them?There is probably at least 10 people on this site who have more knowledge of tx requirements than the majority of GP'S in Aust.

It'd be good if we don't shoot the messenger. Hopefully, we haven't already.

I was seeing a gastroenterologist in US who specialized in liver and hepatitis issues. She didn't know the difference between the European approved treatment for 2B genotype and the US FDA recommendations that REQUIRED ribavirin. She was open minded about generics though and supported the use of the non ribavirin treatment, but...point is, she didn't know before I told her.

GPs are not suitably qualified to manage treatment unless they have undertaken the ASHM s100 hep C prescribing course.

I would have to disagree with this disparaging view of the skills base and capabilities of Australia's GPs. Remember that both GPs and Specialists entered medicine from the top 0.5% of the academic results in that particular year and all did the same medical degree. I'm a GP and graduated in the top 3 of my year. As a group we GPs may have been financially a bit stupid to go down a more holistic path, but we are not, on the whole, a bunch of morons incapable of learning new skills without having our hands held.

Skills relate to what you do a lot of, have an interest in, and take the time to learn about. A Gastroenterologist or ID doctor with no experience in Hep C treatment (that being the majority) are no more or less qualified than a GP.

Several hundred GPs across Australia have completed the course over the past few years and there is a course running in Sydney in March. It is exactly the same with HIV treatment.

As far as I know none of the several hundred GPs across Australia who have completed the S100 course over the past few years received instruction in drugs that at the time did not exist. Calling them qualified after having completed a course that did not cover the relevant material seems unjustified.

One of the problems for doctors coming from the Interferon/Riba age is the notion that using Riba is a good idea. For most patients it is not, it is at best a DAA saving strategy. If you read this fixhepc.com/forum/gt3/369-gt3-high-svr-r...ith-daclatasvir.html (the largest trial of Sof/Dac+/-Riba ever with n=468) there is exactly zero evidence that it helps in any subgroup of F3/F4 GT3 taking 24 weeks treatment. On this note I have just seen a Specialist put an F4 patient with GT3 into hepato-renal failure by, 6 weeks into a 24 week treatment, adding in Riba to a patient with VL 0 at 4 weeks and then normal liver function. 5 days in the patient started to feel bad and went yellow. At 7 days he stopped the Riba. His local GP did some bloods that looked a bit dire. I've been monitoring him quietly getting better.

I would agree with you that anybody prescribing Riba should be aware that it can make things go pear shaped very fast.

Only specialist GPs are qualified to manage issues like drug/drug interactions.

Managing drug interactions is a routine part of medical life. Every GP does it every day, and given GPs do far more prescribing we routinely deal with far more interactions than Specialists. We also routinely use computerised software that provides decision support and annoying interaction warnings (unlike many Specialists who still use paper). In the GP Cheat Sheet there is a dedicated interactions checker my 7 year old could use with 2 minutes instruction.

Fortunately or otherwise these medications will be dual listed as S85 and S100 so no special training for GPs will be required although if Riba is going to be used you could make an argument some training about using it is essential.

As always seeking out a doctor who has an interest and experience dealing with your particular problem is a smart idea.

Suggesting that people could /should make their own decisions on what drug combination they need and how long their treatment should last is extremely dangerous practice and is the prime concern in the medical community regarding the buyers club.

The Buyer's Club requires a doctor's prescription and does not provide access to medications without one. This has always been the position and is clearly stated.

I've learnt just as much from my patients about the latest research as I have off my own bat. I don't see anything dangerous about talking to my patients about how we are going to work together to treat their illness. One of the great things about generics is that we are not dictated to - if you had free choice of 12 weeks with Riba and being unable to function well for 3 months when you have to pay bills and look after children vs 24 weeks without Riba feeling better than you have for years what would you choose - particularly if the outcomes for the 24 weeks were equivalent or better?

Treatment guidelines provide indisputable evidence based recommendations on which medication is suitable for patients depending on genotype, fibrosis, treatment history, comorbidity, etc.

Actually treatment guidelines inevitably trail the best practice evidence by months or years, for example the biggest trial ever of F3/F4 Sof/Dac+/-Riba (fixhepc.com/media/kunena/attachments/391/CCO.pdf) showed that for patients taking 24 weeks treament (the vast majority) the results +Riba were inferior (in every sub group) to the results -Riba. The guidelines still recommend it, and the newly available evidence says that is wrong (www.hepatitisc.uw.edu/pdf/treatment-infe...e-3/core-concept/all)

Nobody should undertake hep C treatment without the supervision of a suitably qualified doctor.

Who is suitably qualified to prescribe a brand new class of medication?

I'm a GP and in the last 6 months I've prescribed and monitored more Sofosbuvir based treatment than every Specialist in Australia combined.

For those things we need to learn before doing them, we learn by doing them.

James-Freeman-facebook wrote:
I'm a GP and in the last 6 months I've prescribed and monitored more Sofosbuvir based treatment than every Specialist in Australia combined.

For that alone Doc there are a great many of us who will be eternally grateful .

Recently someone I know purchased meds from here and received information on what medication they would need. They then saw there GP and asked for a script. He looked up the guidelines wanting to re assure himself that her information was correct but suggested she should check with her specialist first before taking them. He did write the script. She ordered her meds through here and waited for her specialist appointment. Her specialist was horrified not that they were buyers club meds but that she was being grossly under treated . Her particular history required 24 weeks treatment not 12 and also ribavirin.

After that story I think I would want contact with a specialist just to make sure. Yes Gp's have contraindications and drug interaction pop ups with medications. My Gp is an S100 provider for HIV meds and has a special interest in hep c medications but with my complicated history was reluctant to write prescriptions while i was on treatment and always consulted with the clinic first. Okay the meds I had were vikeira pac which probably has the most drug reactions.

None of the GP's I know, and i know a lot, are very aware of HCV meds ,except for what I harass them about ,even though they are very dedicated and conscientious practitioners they have always referred patients onto clinics for treatment and would be loath to prescribe without a lot more information. I was speaking with a group of them yesterday about all of this and they wanted more information. Hopefully it will be forthcoming.