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Published on: February 19, 2019
Characteristics and management of patients with chronic hepatitis B in an integrated care setting
Monika Sarkar1, Valentina A Shvachko, Joanna B Ready
1Viral Hepatitis Registry, Kaiser Permanente Division of Research, Oakland, CA, USA, monika.sarkar@ucsf.edu.
Insights
This study highlights that while most chronic hepatitis B (CHB) patients receiving treatment were eligible, viral DNA and ALT monitoring, along with cancer surveillance, were infrequent, indicating room for improved CHB care.
Area of Science:
- Hepatology
- Viral Hepatitis
- Public Health
Background:
- Limited population-based data exists on chronic hepatitis B (CHB) patient characteristics and management in the USA.
- Understanding CHB care patterns is crucial for improving patient outcomes and public health strategies.
Purpose of the Study:
- To describe the characteristics and management of a large cohort of adults with CHB in the USA.
- To evaluate laboratory testing, treatment patterns, and hepatocellular carcinoma (HCC) surveillance in CHB patients.
Main Methods:
- Retrospective study of 12,016 adults with CHB in Northern California Kaiser Permanente from July 2009 to December 2010.
- Ascertained laboratory tests, treatment, and HCC surveillance using medical records.
- Analyzed data for a recent 18-month window and "ever" based on records since 1995.
Main Results:
- 51% of patients were male, 83% Asian, with a mean age of 49.
- Only 37% saw primary care providers (PCPs) for liver-related visits, while 14% saw specialists.
- Less than 40% had recent HBV DNA and ALT testing; 56% received HCC surveillance.
- Specialist care was associated with more frequent testing and surveillance compared to PCP care (p<0.001).
- 14% received HBV treatment, with 76% of newly treated patients meeting guideline indications.
- 5% of untreated patients showed evidence of treatment eligibility.
Conclusions:
- Most patients initiated on HBV treatment were eligible, with few eligible patients left untreated.
- Inconsistent monitoring of ALT, HBV DNA, and HCC surveillance suggests underestimation of treatment needs.
- Improving viral load monitoring and cancer surveillance are key targets for enhancing CHB care in community settings.
Background:
Few population-based studies have described characteristics and management of patients with chronic hepatitis B (CHB) in the USA.
Methods:
We retrospectively studied adults with CHB in the Northern California Kaiser Permanente Medical Care Program (KPNC) from July 2009 to December 2010 (n = 12,016). Laboratory tests, treatment patterns, and hepatocellular carcinoma (HCC) surveillance were ascertained during a "recent" 18-month study window (July 2009-December 2010), or as "ever" based on records dating to 1995.
Results:
The mean age was 49 years; 51 % were men, 83 % Asian, and 87 % KPNC members >5 years. Overall, 51 % had ≥ 1 liver-related visit, 14 % with gastroenterology or infectious disease specialists, and 37 % with primary care providers (PCP) only. Less than 40 % of patients had both hepatitis B virus (HBV) DNA and ALT testing conducted recently, while 56 % of eligible patients had received HCC surveillance. Recent laboratory testing and HCC surveillance were more frequent in patients seen by a specialist versus PCP only (90 vs. 47 % and 92 vs. 73 %, respectively, p values <0.001). During the study period, 1,649 (14 %) received HBV treatment, while 5 % of untreated patients had evidence of treatment eligibility. Among 599 patients newly initiated on HBV therapy, 76 % had guideline-based indications for treatment.
Conclusions:
Most patients initiated on HBV treatment met eligibility, and very few patients with evidence of needing treatment were left untreated. However, monitoring of ALT and HBV DNA levels, as well as HCC surveillance, were not frequent, underestimating the proportion of patients that warranted HBV therapy. Viral monitoring and cancer surveillance are therefore important targets for improving the scope of CHB care in the community setting.
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