— Christine M. Kukka, Project Manager, HBV Advocate
The latest in a series of studies finds that
primary care physicians–and even gastroenterologists who specialize in
digestive diseases–fail to treat hepatitis B patients who qualify for
treatment.
The latest study by Stanford University Medical Center researchers
compared treatment rates in 1,976 hepatitis B patients seen by primary
care clinics, gastroenterologists (these doctors specialize in
digestive organs, including the liver) and hepatologists
(gastroenterologists who specialize in liver diseases).
All three clinics served patients of similar age,
gender and ethnicity. About 53% of patients treated at gastroenterology
and hepatology clinics should have been treated based on current
medical guidelines due to their liver damage.
However, hepatology clinics treated only 59% of eligible patients and gastroenterology clinics treated only 45% of them.
The reasons doctors gave for failing to render proper treatment included:
- They thought normal alanine aminotransferase
(ALT) levels indicated there was no liver damage and no need for
treatment. ALT levels rise above normal when liver cells are injured or
die from the infection. Medical guidelines recommend treatment, even
if ALT levels are slightly above normal, if patients are older, male
and have elevated viral load depending on their hepatitis B "e" antigen
status.
- Doctors also said they wanted more time to observe patients, and sometimes patients themselves refused treatment.
The reasons hepatologists gave for starting
treatment was because of patients' older age, male gender (which
increases risk of liver disease) and better knowledge of medical
guidelines.
"Community gastroenterology and university liver
clinics treated about one-half to two-thirds of eligible patients,"
researchers noted in their study (1) published in the July issue of the
journal of Digestive Diseases and Sciences. Educating both
providers and patients about the benefits of treatment in the
prevention of liver disease and cancer should occur, they added.
Providers should also be taught that treatment may be needed when
patients' ALT levels are in the upper range of normal.
An unrelated study by the Pacific Health Foundation, published in the July issue of the Journal of Clinical Gastroenterolgy,
came to a similar conclusion. It compared treatment rates by primary
care providers and gastroenterologists over a six-month period.
Using current medical treatment guidelines, they
found that specialists treated eligible patients far more than primary
care providers (45% vs. 25%), but "...there are still a considerable
number of patients from both settings who did not receive treatment
despite being eligible." (2)
Source 1: www.ncbi.nlm.nih.gov/pubmed/25060778
Source 2: www.ncbi.nlm.nih.gov/pubmed/25014233
Source: HBV Journal Review: August 1, 2014, Vol 11, no 8
Labels: lack of treatment, physician awareness, treatment guidelines
