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Published on: May 10, 2022
Prescriber Specialty Involvement in Medicare Patients With Chronic Hepatitis B
Xiaohan Ying1, Nicole Ng1, Deirdre Reidy1
1Department of Medicine, Weill Cornell Medicine, New York City, New York, USA.
Prescriber patterns for chronic hepatitis B (CHB) shifted, with more gastroenterologists and advanced practice providers (APPs) managing care. This trend is crucial for ensuring consistent CHB treatment access amid workforce shortages.
Area of Science:
- Hepatology and Gastroenterology
- Health Services Research
- Public Health
Background:
- Chronic hepatitis B (CHB) significantly contributes to liver disease morbidity and mortality in the U.S.
- CHB patients require continuous antiviral therapy and follow-up, yet face access barriers.
- Understanding prescriber trends is vital for optimizing CHB patient care delivery.
Purpose of the Study:
- To analyze specialty and geographic trends in healthcare providers managing Medicare patients with CHB.
- To identify shifts in prescribing patterns for CHB therapies between 2013 and 2021.
Main Methods:
- Utilized the Medicare Part D database and Rural-Urban Continuum codes.
- Examined over 2.4 million 30-day prescriptions for CHB therapies from 2013-2021.
- Analyzed prescriber specialty (Gastroenterology, Advanced Practice Providers, Infectious Disease, Primary Care) and geographic location (metropolitan vs. non-metropolitan counties).
Main Results:
- Total CHB prescriptions increased by 5.4% annually, with 85% in metropolitan areas.
- Gastroenterology (GI) and Advanced Practice Provider (APP) prescriptions grew significantly (12.5% and 12.2% annually, respectively).
- Infectious Disease (ID) prescriptions decreased by 14.0% annually; APPs and Primary Care Providers (PCPs) saw declines in non-metropolitan areas.
Conclusions:
- A notable shift occurred, with increased involvement of Gastroenterologists and APPs in prescribing CHB medications.
- The rise in APP management is beneficial given physician shortages, but requires careful integration.
- Strategies like co-management are needed to ensure consistent CHB care and address potential workforce imbalances.
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