Tamara Leah Remington1,2, Mariam Osman3, Kimberley Simmonds3,4,5, Carmen L Charlton6,7, Karen Doucette1. 1. Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 2. Grey Nuns Community Hospital, Edmonton, Alberta, Canada. 3. Alberta Ministry of Health, Edmonton, Alberta, Canada. 4. School of Public Health, University of Alberta, Edmonton, Alberta, Canada. 5. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 6. Provincial Laboratory for Public Health, Edmonton, Alberta, Canada. 7. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
Abstract
Background: Patients with chronic hepatitis B (CHB) are at risk of complications and require lifelong monitoring. We evaluated the care of newly diagnosed CHB patients. Methods: Adult CHB cases newly diagnosed in Alberta between January 1, 2008, and December 31, 2012, were identified, with follow-up through June 1, 2014. Rates of completion of baseline investigations, receipt of antiviral therapy when indicated, and adherence to hepatocellular carcinoma (HCC) screening recommendations in a cohort of high-risk patients were compared between those who did or did not see a CHB specialist. Results: Of 3,333 patients with CHB, 87.1% (n = 2,904) received non-specialty care. Specialty assessment was associated with higher completion of alanine aminotransferase, hepatitis B e antigen (HBeAg), anti-HBe, and hepatitis B DNA (p <0.0001) and all four parameters (86.5%) compared with non-specialist care (42.7%; p <0.0001). In a subgroup of high-risk patients for HCC, specialty care was associated with higher completed baseline abdominal ultrasounds (n = 44; 89.8%,) compared with non-specialist care (62.5%; n = 320; p = 0.0001) and greater adherence to annual surveillance (30.6% versus 15.2%; p = 0.0057). Patients in the HBeAg-positive chronic hepatitis phase meeting criteria for antiviral therapy were more likely to receive treatment under specialty care (n = 6; 75.0%) than non-specialty care (n = 27; 33.3%; p = 0.0478). Conclusions: Our study highlights inadequate care among newly diagnosed CHB patients in Alberta. Specialty assessment was associated with improved quality of care. Interventions are needed to improve linkage to specialty care.
Background: Patients with chronic hepatitis B (CHB) are at risk of complications and require lifelong monitoring. We evaluated the care of newly diagnosed CHB patients. Methods: Adult CHB cases newly diagnosed in Alberta between January 1, 2008, and December 31, 2012, were identified, with follow-up through June 1, 2014. Rates of completion of baseline investigations, receipt of antiviral therapy when indicated, and adherence to hepatocellular carcinoma (HCC) screening recommendations in a cohort of high-risk patients were compared between those who did or did not see a CHB specialist. Results: Of 3,333 patients with CHB, 87.1% (n = 2,904) received non-specialty care. Specialty assessment was associated with higher completion of alanine aminotransferase, hepatitis B e antigen (HBeAg), anti-HBe, and hepatitis B DNA (p <0.0001) and all four parameters (86.5%) compared with non-specialist care (42.7%; p <0.0001). In a subgroup of high-risk patients for HCC, specialty care was associated with higher completed baseline abdominal ultrasounds (n = 44; 89.8%,) compared with non-specialist care (62.5%; n = 320; p = 0.0001) and greater adherence to annual surveillance (30.6% versus 15.2%; p = 0.0057). Patients in the HBeAg-positive chronic hepatitis phase meeting criteria for antiviral therapy were more likely to receive treatment under specialty care (n = 6; 75.0%) than non-specialty care (n = 27; 33.3%; p = 0.0478). Conclusions: Our study highlights inadequate care among newly diagnosed CHB patients in Alberta. Specialty assessment was associated with improved quality of care. Interventions are needed to improve linkage to specialty care.
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