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Low Treatment Rates in Patients Meeting Guideline Criteria in Diverse Practice Settings

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Abstract

Background and Aims

Data on usage of antiviral therapy and application of chronic hepatitis B (CHB) management guidelines in different settings are limited. Our goal is to evaluate the proportion of treatment-eligible patients by 6-month follow-up and treatment rate among eligible patients by 12-month follow-up in diverse settings.

Methods

In this retrospective cohort study, 1,976 treatment-naïve CHB patients were categorized as primary care physician (PCP) group if seen by community PCP (n = 329), gastroenterology (GI) group if seen by community gastroenterologists (n = 1,268), and hepatology group if seen by university hepatologists (n = 379). Treatment eligibility was based on the US Panel 2008 and American Association for the Study of Liver Diseases (AASLD) 2009 guidelines.

Results

All groups had similar age, gender, and ethnic distribution. GI and hepatology groups had similar treatment eligibility rates by US Panel (53–54 %) and AASLD guidelines (24–25 %). However, treatment rate was significantly higher in hepatology compared to GI group by the US Panel guideline (59 vs. 45 %, P = 0.001). PCP group had the lowest eligibility and treatment rates by both guidelines. Common reasons for non-treatment were perceived “normal” alanine aminotransferase, desire for further observation, and patient refusal. Male gender, age >50, and subspecialty care predicted treatment initiation in treatment-eligible patients.

Conclusions

Less than half of treatment-eligible patients at primary care clinics received treatment. Community gastroenterology and university liver clinics treated about one-half to two-thirds of eligible patients. Patient and provider education should highlight treatment benefits and the new alanine aminotransferase upper limit of normal.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

ALT:

Alanine aminotransferase

CHB:

Chronic hepatitis B

GI:

Gastroenterology

HBeAg:

Hepatitis B e antigen

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

OR:

Odds ratio

PCP:

Primary care physician

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Acknowledgments

Lily H. Kim was supported in part by the Human Biology Program and Undergraduate Academic Life at Stanford University.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA

    Lily H. Kim & Mindie H. Nguyen

  2. Pacific Health Foundation, San Jose, CA, USA

    Vincent G. Nguyen & Huy N. Trinh

  3. San Jose Gastroenterology, San Jose, CA, USA

    Huy N. Trinh

  4. Gastroenterology, Palo Alto Medical Foundation, Mountain View, CA, USA

    Jiayi Li

  5. Chinese Hospital, San Francisco, CA, USA

    Jian Q. Zhang

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  1. Lily H. Kim
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  2. Vincent G. Nguyen
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Correspondence to Mindie H. Nguyen.

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Kim, L.H., Nguyen, V.G., Trinh, H.N. et al. Low Treatment Rates in Patients Meeting Guideline Criteria in Diverse Practice Settings. Dig Dis Sci 59, 2091–2099 (2014). https://doi.org/10.1007/s10620-014-3283-3

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  • DOI: https://doi.org/10.1007/s10620-014-3283-3

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