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[Follow-up diagnostics, referral and follow-up of hepatitis B and C patients]
R Hofman1,2, Irene K Veldhuijzen3, Johan van der Lei4
1Erasmus MC, Instituut Maatschappelijke Gezondheidszorg, Rotterdam.
Insights
Most patients diagnosed with hepatitis B (HBV) or C (HCV) receive appropriate specialist referral and follow-up diagnostics. However, consistent annual ALT testing for non-referred HBV patients needs improvement, suggesting a need for reminders.
Area of Science:
- Hepatology
- General Practice
- Public Health
Background:
- Hepatitis B (HBV) and C (HCV) infections require specific diagnostic and management pathways.
- Adherence to practice guidelines ensures optimal patient outcomes in primary care settings.
Purpose of the Study:
- To evaluate adherence to Dutch practice guidelines for HBV and HCV follow-up diagnostics and specialist referral.
- To assess the consistency of secondary care referrals and follow-up protocols after initial diagnosis in general practice.
Main Methods:
- Retrospective cohort study utilizing data from the Dutch 'Integrated primary care information' (IPCI) database.
- Manual validation of patient records for individuals with first-time positive HBsAg or anti-HCV tests between 2008-2015.
- Data extraction on follow-up diagnostics, referral status, and subsequent patient follow-up.
Main Results:
- High rates of specialist referral (90% for eligible HBV, 87% for eligible HCV) were observed.
- Most HBV patients received appropriate follow-up diagnostics, including HBeAg and ALT testing.
- Inconsistent annual ALT testing was noted for HBV patients not eligible for referral (only 16% received three tests over time).
Conclusions:
- Current practice largely aligns with guidelines regarding specialist referral for HBV and HCV patients.
- Follow-up diagnostic protocols, particularly annual ALT testing for non-referred HBV patients, require enhancement.
- Implementing reminders for general practitioners and patients may improve adherence to long-term monitoring protocols.
Objective:
To study the extent to which follow-up diagnostics, referral to secondary care and follow-up are in accordance with the practice guideline of the Dutch College of General Practitioners 'Viral hepatitis and other liver disorders' after a hepatitis B (HBV) or C (HCV) infection has been diagnosed at the general practice.
Design:
Retrospective cohort study.
Method:
Patient records were obtained from the Dutch 'Integrated primary care information' (IPCI) database which contains data from patients from general practices. Records of patients with a first-time positive HBsAg or anti-HCV test result in the period between 2008 and 2015 were manually validated and data on follow-up diagnostics, referral and follow-up were found.
Results:
A total of 117 patients tested positive for HBsAg and 101 patients tested positive for anti-HCV. Most HBV patients were subsequently tested for HBeAg (92%) and ALT (80%). Of the 41 HBV patients who were eligible for referral, 37 (90%) were actually referred to a specialist. 49 HCV patients (49%) were found negative after a confirmation or RNA test. 87% of the remaining 52 HCV patients were referred (n = 45). 21 (43%) of the 49 HBV patients who were not eligible for referral were tested for ALT after an average of 11.5 months. 14 (29%) of these patients subsequently received a second follow-up ALT test and 8 (16%) received a third.
Conclusion:
Almost all HBV and HCV patients who are eligible for referral, are actually referred to a specialist. Most HBV patients received the correct follow-up diagnostics after a positive HbsAg test result. However, in few HBV patients who were not eligible for referral, was the ALT level checked every year for three years. The general practitioner, as well as the patient, should receive a reminder for this.
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