Chronic Hepatitis B Management Based on Standard Guidelines in Community Primary Care and Specialty Clinics
Chronic Hepatitis B Management Based on Standard Guidelines in Community Primary Care and Specialty Clinics
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DOI：
10.1007/s10620-013-2889-1
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发表时间：
2013-12-01
影响因子：
3.1
通讯作者：
Nguyen, Mindie H.
中科院分区：
文献类型：
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作者：
Ku, Kevin C.;Li, Jiayi;Nguyen, Mindie H.
先前的研究强调了提高慢性乙肝(CHB)筛查和认识的必要性，特别是在某些高危人群中。然而，很少有研究根据常用的专业指南检查初级保健医生(PCP)和专科医生之间对CHB的评估和管理模式。我们的目标是检查用于确定疾病状态和抗病毒治疗资格的必要实验室参数是否由PCP和专科医生执行。我们对2007年3月至2009年6月在社区多专科医疗中心接受PCP评估(n=63)或由专家评估(n=190)CHB的253名未接受治疗的CHB患者进行了回顾性研究。慢性乙肝管理和治疗资格的标准基于美国肝病研究协会2007年指南和美国专家小组2006年的算法。最佳评估慢性乙型肝炎所需的参数包括乙肝e抗原(HBeAg)、HBVDNA和丙氨酸氨基转移酶(ALT)。治疗慢性乙型肝炎的首选抗病毒药物包括聚乙二醇化干扰素、阿德福韦和恩替卡韦。大多数患者是亚洲人(90%)和男性(54%)，平均年龄43+/-A11.6岁。与PCP相比，专家更倾向于要求对ALT(94vs.86%，P=0.0001)、HBeAg(67vs.41%，P<；0.0001)和HBVdna(83vs.52%，P<；0.0001)进行实验室检测。在接受专家评估的患者中，拥有所有三项实验室参数的患者比例明显高于PCP患者(62%比33%，P<；0.0001)。共有55名患者开始接受抗病毒治疗(47名由专科医生治疗，6名由初级保健医生治疗)。儿科医生开拉米夫定的频率高于专科医生(33%比2%，P=0.05)。专科医生使用首选药物的比例为96%，而接受PCP治疗的患者使用首选药物的比例为67%(P=0.05)。与仅由PCP评估的患者相比，由专家评估的CHB患者更有可能接受更全面的实验室评估，如果符合条件，也更有可能使用首选的长期药物治疗CHB。包括PCP和专家在内的协作护理模式可能会进一步优化CHB患者的管理。
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.We conducted a retrospective study of 253 treatment-na < ve 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.The majority of patients were Asians (90 %) and male (54 %) with a mean age of 43 +/- A 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).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.