BMC Public Health 2006, 6:3 http://www.biomedcentral.com/1471-2458/6/3 Table 4: Pattern of drug prescribing by CSP (2001) Drug regime used by CSP Interferon alone Interferon & Ribavirin Pegylated Interferon & ribavirin Pegylated interferon alone % of patients receiving a particular drug regime as a % of overall prescribing by CSP* (Median) Number of CSPs using drug regime 0–5 20 25–49 64 50–74 57 0–5 24 and allocated to three categories which indicate increasing severity of disease Class A (5–6 points) Class B (7–9 points) Class C (10–15 points). Class A has a better prog- nosis than B, which in turn has a better prognosis than class C). Two thirds (66%) of respondents currently used inter- feron and ribavirin combination therapy and a majority (59%) were using pegylated interferons. Those CSPs who used pegylated interferon and ribavirin used it in 50–74% of treated patients (median), and those CSPs who used interferon and ribavirin used this regime in 25–49% of treated patients (median) (see Table 4). Interferon and pegylated interferon alone were used in the minority of patients treated by CSPs (0–5%), Just over half (52%) of CSPs reported that they used printed guidelines for dose reduction and stopping therapy and 35% performed post treatment liver biopsy. The median rate of adherence to treatment reported was 75–90%, with the main reasons for stopping treatment being 'patient initiated' and 'side effects'. There were no significant differences in the percentage of CSPs reporting higher levels of adherence by clinical specialty, presence of a specialist nurse, or size of unit though the study is underpowered to detect any differences. For those patients not receiving treatment there was varia- tion in practice for the follow-up of patients with different degrees of severity of hepatitis. The median follow-up for patients not on treatment with mild hepatitis was annu- Table 5: Barriers to providing a high quality service Reason Clinic waiting times Biopsy waiting time Staffing Capacity Staffing Skill mix Funding for Treatment Patient Refusal Patient non- attendance Patient Identification 58 45 76 42 72 32 80 31 ally (66%), for moderate hepatitis it was every 6 months (55%), and for severe hepatitis and cirrhosis it was every 3 months (47%). The majority of CSPs (62%) had a database to record information about patients with HCV and another 12% were in the process of establishing a database. This varied by clinical speciality from 57% for GI led units, 88% for hepatologist and 93% for ID. 15 data systems were in paper format and 57 were electronic (some units main- tained both forms). There was concordance of minimum data items collected. Barriers to providing a high quality service for patients with Hepatitis C 82% of CSPs reported barriers in the management of patients with Hepatitis C. The main factors are shown in Table 5. Funding, staff capacity and patient non-attend- ance were the most common. Biopsy waiting times showed some differences between specialities, with 17 hepatologists and 4 ID physicians agreeing/strongly agreeing that biopsy times are a barrier to care, and 6 Hepatologists and 9 ID physicians disagreeing. Geographical distribution of services In England, 27 out of 28 Strategic Health Authorities (SHAs) had a CSP within their boundary (Figure 1). The size of the CSP and the clinical discipline of the lead var- ied, with some SHAs having a few smaller centres, and others a single large provider. ID led units were concen- trated in the North/Midlands of England and Scotland. 3 3 12 15 4 19 3 31 39 52 16 43 24 49 17 29 Page 5 of 9 (page number not for citation purposes) Agree/strongly agree% Unsure % Disagree /strongly disagree %