title: Characteristics and management of patients with chronic hepatitis B in an integrated care setting.
abstract: BACKGROUND
  Few population-based studies have described characteristics and management of patients with chronic hepatitis B (CHB) in the USA.
  
  
  METHODS
  We retrospectively studied adults with CHB in the Northern California Kaiser Permanente Medical Care Program (KPNC) from July 2009 to December 2010 (n = 12,016). Laboratory tests, treatment patterns, and hepatocellular carcinoma (HCC) surveillance were ascertained during a "recent" 18-month study window (July 2009-December 2010), or as "ever" based on records dating to 1995.
  
  
  RESULTS
  The mean age was 49 years; 51 % were men, 83 % Asian, and 87 % KPNC members >5 years. Overall, 51 % had ≥ 1 liver-related visit, 14 % with gastroenterology or infectious disease specialists, and 37 % with primary care providers (PCP) only. Less than 40 % of patients had both hepatitis B virus (HBV) DNA and ALT testing conducted recently, while 56 % of eligible patients had received HCC surveillance. Recent laboratory testing and HCC surveillance were more frequent in patients seen by a specialist versus PCP only (90 vs. 47 % and 92 vs. 73 %, respectively, p values <0.001). During the study period, 1,649 (14 %) received HBV treatment, while 5 % of untreated patients had evidence of treatment eligibility. Among 599 patients newly initiated on HBV therapy, 76 % had guideline-based indications for treatment.
  
  
  CONCLUSIONS
  Most patients initiated on HBV treatment met eligibility, and very few patients with evidence of needing treatment were left untreated. However, monitoring of ALT and HBV DNA levels, as well as HCC surveillance, were not frequent, underestimating the proportion of patients that warranted HBV therapy. Viral monitoring and cancer surveillance are therefore important targets for improving the scope of CHB care in the community setting.
authors.affiliation: Viral Hepatitis Registry, Kaiser Permanente Division of Research, Oakland, CA, USA, monika.sarkar@ucsf.edu.
authors.forename: Monika
authors.initials: M
authors.lastname: Sarkar
authors.forename: Valentina A
authors.initials: VA
authors.lastname: Shvachko
authors.forename: Joanna B
authors.initials: JB
authors.lastname: Ready
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Pauly
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
authors.forename: M Michele
authors.initials: MM
authors.lastname: Manos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D002140:California; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis*; D004279:DNA, Viral / Q000097:blood*; D019033:Delivery of Health Care, Integrated; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D055552:Infectious Disease Medicine / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D057832:Watchful Waiting; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins; D000410:Alanine Transaminase
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