Clinical pathways for patients with newly diagnosed hepatitis C - What actually happens
Clinical pathways for patients with newly diagnosed hepatitis C - What actually happens
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DOI：
10.1111/j.1365-2893.2005.00698.x
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发表时间：
2006-04-01
影响因子：
2.5
通讯作者：
Hippisley-Cox, J
中科院分区：
文献类型：
--
作者：
Irving, WL;Smith, S;Hippisley-Cox, J
丙型肝炎病毒（HCV）感染者的管理需要转诊到专科护理。确定新诊断为抗-HCV阳性的患者是否适当转诊进行进一步调查和管理，如果否，确定原因。我们研究了诺丁汉公共卫生实验室在2年期间（2000-2002年）检测HCV抗体的患者。记录新诊断的抗-HCV阳性患者进入专科诊所进行进一步管理的进展。对于未转诊的患者，向临床医生发送问卷，要求进行初始抗HCV检测，以确定未转诊的原因。对11177例患者进行了抗HCV检测。新诊断出抗-HCV阳性的有五十六人（2.3%）。从初级保健发送的样本中有2%是抗-HCV阳性，而从监狱、毒品和酒精单位以及二级保健发送的样本分别为18.8%、18.9%和1.3%。在初级保健中诊断的阳性患者中约有64.3%被转介到专科护理，而在其他三种环境中诊断的患者分别为18.4%、42.4%和62.6%。125例（49%）新诊断患者被适当转诊以进行进一步管理。其中68人参加了临床，45人接受了肝活检，26人（10%）开始治疗。131例患者（51%）未转诊。在54例病例中，没有证据表明抗-HCV阳性结果到达患者。在15例患者中，考虑转诊但被拒绝，20例患者被转诊至非HCV专家（他们的全科医生或泌尿生殖医学）。因此，不到50%的新诊断的抗-HCV阳性患者被转介到适当的诊所进行进一步的调查和管理。造成这种情况的原因是多种多样和复杂的，既反映了系统故障，也反映了患者的选择。除非这些问题得到理解和解决，否则卫生部丙型肝炎战略（2002年）和英格兰行动计划（2004年）将无法实现其预期目标。
Management of hepatitis C virus (HCV)-infected individuals requires referral to specialist care. To determine whether patients newly diagnosed as anti-HCV positive are appropriately referred for further investigation and management, and if not, to determine why not. We studied patients tested for antibodies to HCV by Nottingham Public Health Laboratory in a 2-year period (2000-2002). The progress of newly diagnosed anti-HCV positive patients into specialist clinics for further management was documented. For patients not referred for specialist care, a questionnaire was sent to the clinician requesting the initial anti-HCV test, to identify reasons for nonreferral. Eleven thousand one hundred and seventy-seven patients were tested for anti-HCV. Two hundred and fifty-six (2.3%) were newly diagnosed as being anti-HCV positive. Two per cent of samples sent from primary care were anti-HCV positive, compared to 18.8, 18.9 and 1.3% sent from prison, drug and alcohol units, and secondary care, respectively. About 64.3% of positive patients diagnosed in primary care were referred to specialist care, compared to 18.4, 42.4 and 62.6% of patients diagnosed in the other three settings. One hundred and twenty-five (49%) newly diagnosed patients were referred appropriately for further management. 68 of these attended clinic, 45 underwent liver biopsy and 26 (10%) began treatment. One hundred and thirty-one patients (51%) were not referred. In 54 cases, there was no evidence that the anti-HCV positive result reached the patient. In 15, referral was considered but rejected, and 20 patients were referred to non-HCV-specialists (their general practitioners or to genito-urinary medicine). Hence less than 50% of newly diagnosed anti-HCV positive patients are referred to an appropriate clinic for further investigation and management. Reasons for this are multifarious and complex, reflecting both systems failure and patient choice. Unless these are understood and addressed, the Department of Health Hepatitis C Strategy (2002) and Action Plan for England (2004) will fail to achieve their intended objectives.