title: Low treatment rates in patients meeting guideline criteria in diverse practice settings.
abstract: OBJECTIVE
  Data on usage of antiviral therapy and application of chronic hepatitis B (CHB) management guidelines in different settings are limited. Our goal is to evaluate the proportion of treatment-eligible patients by 6-month follow-up and treatment rate among eligible patients by 12-month follow-up in diverse settings.
  
  
  METHODS
  In this retrospective cohort study, 1,976 treatment-naïve CHB patients were categorized as primary care physician (PCP) group if seen by community PCP (n = 329), gastroenterology (GI) group if seen by community gastroenterologists (n = 1,268), and hepatology group if seen by university hepatologists (n = 379). Treatment eligibility was based on the US Panel 2008 and American Association for the Study of Liver Diseases (AASLD) 2009 guidelines.
  
  
  RESULTS
  All groups had similar age, gender, and ethnic distribution. GI and hepatology groups had similar treatment eligibility rates by US Panel (53-54 %) and AASLD guidelines (24-25 %). However, treatment rate was significantly higher in hepatology compared to GI group by the US Panel guideline (59 vs. 45 %, P = 0.001). PCP group had the lowest eligibility and treatment rates by both guidelines. Common reasons for non-treatment were perceived "normal" alanine aminotransferase, desire for further observation, and patient refusal. Male gender, age >50, and subspecialty care predicted treatment initiation in treatment-eligible patients.
  
  
  CONCLUSIONS
  Less than half of treatment-eligible patients at primary care clinics received treatment. Community gastroenterology and university liver clinics treated about one-half to two-thirds of eligible patients. Patient and provider education should highlight treatment benefits and the new alanine aminotransferase upper limit of normal.
authors: Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA, lilyhkim@stanford.edu.
authors: Lily H
authors: LH
authors: Kim
authors: Vincent G
authors: VG
authors: Nguyen
authors: Huy N
authors: HN
authors: Trinh
authors: Jiayi
authors: J
authors: Li
authors: Jian Q
authors: JQ
authors: Zhang
authors: Mindie H
authors: MH
authors: Nguyen
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000592:standards / Q000706:statistics & numerical data; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005762:Gastroenterology / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000410:Alanine Transaminase