title: Are physicians following guidelines? A survey of Hepatitis B management strategies.
abstract: OBJECTIVE
  Practice guidelines for chronic hepatitis B (CHB) assist physicians in management; however, there are also areas where they provide no guidance. This paper aimed to examine treatment preferences for CHB among physicians based upon the Asia Pacific Association for the Study of the Liver (APASL) consensus guidelines 2008.
  
  
  METHODS
  A questionnaire was prepared consisting of 18 questions grouped into 8 sections: basic information of participants, the proportion and number of CHB patients on treatment, case scenarios of treatment initiation, preferences for antiviral therapy, scenarios for stopping and continuing antiviral therapy, monitoring patients during therapy, and viral resistance management. The questionnaire was introduced to the APASL 2009 conference delegates.
  
  
  RESULTS
  A total of 508 participants from 34 countries participated in the survey. Lamivudine or peg-interferon monotherapy was the preferred first-line therapy, while lamivudine/adefovir combination was the drug of choice for rescue therapy. Drug efficacy and cost were the most important factors to consider before initiating treatment, while viral resistance had a low priority. In general, the APASL guideline was strictly followed in about 50-60 % of the scenarios (initiating, stopping, or continuing antiviral therapy).
  
  
  CONCLUSIONS
  The survey concluded that clinical management preferences differed from APASL guidelines in many instances.
authors.affiliation: Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, 1E Lower Kent Ridge Road, Tower Block, Level 10, Buona Vista, 119228, Singapore. keat_hong_lee@nuhs.edu.sg.
authors.forename: Keat Hong
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, 1E Lower Kent Ridge Road, Tower Block, Level 10, Buona Vista, 119228, Singapore. myat_oo_aung@nuhs.edu.sg.
authors.forename: Myat Oo
authors.initials: MO
authors.lastname: Aung
authors.affiliation: Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, 1E Lower Kent Ridge Road, Tower Block, Level 10, Buona Vista, 119228, Singapore. seng_gee_lim@nuhs.edu.sg.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Buona Vista, Singapore. seng_gee_lim@nuhs.edu.sg.|Department of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Buona Vista, 119074, Singapore. seng_gee_lim@nuhs.edu.sg.
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
keywords: APASL guidelines; Chronic hepatitis B; Management; Questionnaire