Baseline assessment of and linkage to care for newly diagnosed patients with chronic hepatitis B

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.