Identification and management of hepatitis C patients in primary care clinics.

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Identification and management of hepatitis C patients in primary care

clinics.

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Am J Gastroenterol. 2003; 98(3):639-44 (ISSN: 0002-9270)

Shehab TM; Orrego M; Chunduri R; Lok AS

Division of Gastroenterology, Department of Internal Medicine, University

of Michigan Health System, Ann Arbor, Michigan 48109, USA.

OBJECTIVE: Previous survey-based research suggested that hepatitis C

patients receive suboptimal care in primary care settings. The aim of our

study was to define the actual level of care hepatitis C patients receive

in primary care clinics. METHODS: Medical records of 229 hepatitis C

antibody-positive (group 1), 229 hepatitis C antibody-negative (group 2),

and 229 patients not tested for hepatitis C antibody (group 3) were

reviewed to assess the indications for hepatitis C testing and the

subsequent management and referral of hepatitis C antibody-positive

patients diagnosed in primary care clinics. In addition, the compliance of

primary care physicians with hepatitis C screening and testing guidelines

was assessed. RESULTS: Only 16% of group 1 and 10% of group 2 patients

were tested for hepatitis C based on physician-identified risk factors.

Only 1% of group 3 patients had documented discussion of hepatitis C risk

factors during their initial visit with a primary care physician. The

majority of hepatitis C antibody-positive patients was appropriately

evaluated in primary care clinics, and most (77%) hepatitis C RNA-positive

patients with elevated liver enzymes were referred for subspecialty care.

Of the 59 patients who underwent liver biopsy, 40% had bridging fibrosis

or cirrhosis. CONCLUSIONS: Hepatitis C testing is rarely initiated in

primary care clinics based on physician-identified risk factors.

Interventions should be developed to optimize early diagnosis of hepatitis

C as significant liver disease may be present despite the absence of

symptoms.

Subject Headings

PreMedline Identifier: 12650800

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