Digestive Diseases and Sciences

, Volume 58, Issue 12, pp 3626–3633

Chronic Hepatitis B Management Based on Standard Guidelines in Community Primary Care and Specialty Clinics

  • Kevin C. Ku
  • Jiayi Li
  • Nghi B. Ha
  • Marina Martin
  • Vincent G. Nguyen
  • Mindie H. Nguyen
Original Article

Abstract

Background and Aims

Prior studies have underlined the need for increased screening and awareness of chronic hepatitis B (CHB), especially in certain high-risk populations. However, few studies have examined the patterns of evaluation and management of CHB between primary care physicians (PCP) and specialists according to commonly-used professional guidelines. Our goal was to examine whether necessary laboratory parameters used to determine disease status and eligibility for antiviral therapy were performed by PCPs and specialists.

Methods

We conducted a retrospective study of 253 treatment-naïve CHB patients who were evaluated by PCP only (n = 63) or by specialists (n = 190) for CHB at a community multispecialty medical center between March 2007 and June 2009. Criteria for CHB management and treatment eligibility were based on the American Association for the Study of Liver Diseases 2007 guideline and the US Panel 2006 algorithm. Required parameters for optimal evaluation for CHB included hepatitis B e antigen (HBeAg), HBV DNA, and alanine aminotransferase (ALT). Preferred antiviral agents for CHB included pegylated interferon, adefovir, and entecavir.

Results

The majority of patients were Asians (90 %) and male (54 %) with a mean age of 43 ± 11.6 years. Compared to PCPs, specialists were more likely to order laboratory testing for ALT (94 vs. 86 %, P = 0.05), HBeAg (67 vs. 41 %, P < 0.0001) and HBV DNA (83 vs. 52 %, P < 0.0001). The proportion of patients having all three laboratory parameters was significantly higher among those evaluated by specialists compared to PCP (62 vs. 33 %, P < 0.0001). A total of 55 patients were initiated on antiviral treatment (n = 47 by specialists and n = 6 by PCPs). Lamivudine was prescribed more often by PCPs than specialists (33 vs. 2 %, P = 0.05). Preferred agents were used 96 % of the time by specialists compared to 67 % of those treated by PCPs (P = 0.05).

Conclusion

Patients evaluated by specialists for CHB are more likely to undergo more complete laboratory evaluation and, if eligible, are also more likely to be treated with preferred longer-term agents for CHB compared to those evaluated by PCPs only. A collaborative model of care involving both PCP and specialists may further optimize management of patients with CHB.

Keywords

Hepatitis B virus Asian American Hepatitis B treatment guidelines Primary care physicians 

List of Abbreviations

HBV

Hepatitis B virus

CHB

Chronic hepatitis B

HBeAg

Hepatitis B e antigen

HCC

Hepatocellular carcinoma

AASLD

American Association for the Study of Liver Diseases

US Panel

United States Panel hepatologists

PCP

Primary care physicians

ALT

Alanine aminotransferase

ULN

Upper limit of normal

IU

International unit

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kevin C. Ku
    • 1
    • 2
  • Jiayi Li
    • 3
  • Nghi B. Ha
    • 4
  • Marina Martin
    • 6
  • Vincent G. Nguyen
    • 2
  • Mindie H. Nguyen
    • 2
    • 5
  1. 1.College of Osteopathic MedicineTouro University NevadaHendersonUSA
  2. 2.Santa Clara Valley Medical CenterSan JoseUSA
  3. 3.Gastroenterology DepartmentPalo Alto Medical FoundationMountain ViewUSA
  4. 4.School of PharmacyUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoUSA
  6. 6.Department of MedicineStanford University Medical CenterStanfordUSA

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