(324) Factors Associated with Compliance to The Hepatotoxicity Risk Management Guide in Primary Care Facilities in Casablanca, Morocco

Publication Number: 999

Background: Antituberculosis drugs can cause frequent and potentially serious adverse events (AEs) with hepatotoxicity one of the most common adverse events reported with these agents. To facilitate patient safety, the American Thoracic Society (ATS) has issued guidelines for the management of antituberculosis drug-induced hepatotoxicity (ATH), however the extent to which Moroccan physicians comply with these guidelines in daily practice is unknown.

Objectives: To determine the factors that may be associated with compliance with the ATH management guide in primary care facilities in Casablanca

Methods: A cross-sectional study of primary care facilities in Casablanca between March and July 2020 was conducted. Self-reported data regarding the daily practice around diagnosis, management and re-challenge of anti-tuberculosis medications following ATH was collected from general practitioners via a self-administered questionnaire. Self-reported practice was compared with the recommendations in the American Thoracic Society (ATS) ATH management guidelines and physicians following at least 75% of the ATS ATH recommendations were considered to be complaint with the guidelines for each area (diagnosis, management, rechallenge). Multivariate logistic regression was used to identify factors associated with guideline compliance.

Results: Of the 125 physicians practicing in the public primary care structures of Casablanca, 93 agreed to participate in our study. The average age of the participants was 41.58±8.75 years with a mean of 10.56±5.96 years of practice. Across all areas, 32.6% of physicians were complaint with the ATS guideline. In terms of diagnosis, 89.9% of physicians complied with the guidelines for diagnosis of symptomatic patients but this reduced to 50.6% for diagnosis of asymptomatic patients. Initial management guidelines for ATH were followed by 75.3% of physicians. Rechallenge practices were consistent with the ATH management guideline for 43.2% of physicians. In multivariate analysis, except for having received TB training in the previous 12 months (OR= 3.22; 95% CI= [1.18 ;8.94]), no other factors (Gender, age, place and years of practice) were statistically associated with compliance with the ATH management guidelines.

Conclusions: This cross-sectional study showed that in general the management practices for ATH in primary care facilities in Casablanca do not conform to the ATS guidelines. We found that education on management of TB was associated with increased compliance indicating that physician education is in strategy likely to increase physician management at ATH in primary care.