1*Pacific Health Foundation ‡San Jose Gastroenterology, San Jose †Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto §Department of Gastroenterology, Palo Alto Medical Foundation, Mountain View ∥Chinese Hospital, San Francisco, CA.
This study aims to compare the eligibility and treatment rates of patients evaluated by gastroenterology [gastrointestinal (GI)] specialists for chronic hepatitis B (CHB) and patients followed by their primary care physicians (PCPs) only.
Guidelines have been devised to direct the care of patients with CHB but data on the application of these guidelines, especially in primary care settings, has been limited to date.
Consecutive CHB patients were enrolled retrospectively from several community clinics in the San Francisco Bay Area: 2 GI referral clinics, 3 primary care clinics, and a multispecialty medical center. Patients were classified as group 1 if they saw a gastroenterologist for CHB within 6 months of presentation or as group 2 if they only saw PCPs. Eligibility according to AASLD 2009 and US Panel 2008 guidelines was determined using clinical and laboratory data available within 6 months of presentation.
Patients in group 2 had lower eligibility rates according to both US Panel 2008 (32% vs. 51%, P<0.001) and AASLD 2009 (8% vs. 24%, P<0.001) guidelines. GI specialists treated US Panel-eligible patients more readily than PCPs (45% vs. 25%, P<0.001), and treatment rates in AASLD-eligible patients suggested a similar trend (68% vs. 50%, P=0.080).
GI specialists were more likely than PCPs to see patients who were treatment eligible, and also more likely to initiate antiviral therapy. However, there are still a considerable number of patients from both settings who did not receive treatment despite being eligible.