title: Adherence to follow-up and treatment recommendations in Greek and immigrant patients with chronic hepatitis B in Greece.
abstract: OBJECTIVE
  Immigrants have multiple barriers to access to health care systems. We evaluated the adherence to follow-up and treatment recommendations of chronic hepatitis B virus (HBV) Greek and immigrant patients.
  
  
  METHODS
  In total, 1001 consecutive adult patients with chronic HBV infection who visited our clinics for the first time between 2002 and 2011 were included. All patients born outside Greece were considered immigrants. Diagnosis was considered to be complete if patients could be classified into HBeAg-positive chronic hepatitis B (CHB), inactive carriers, HBeAg-negative CHB, or decompensated cirrhosis.
  
  
  RESULTS
  Of the patients, 56% were Greeks and 44% were immigrants. Greeks visited our clinics at a significantly older mean age (50 vs. 35 years, P<0.001) and more frequently with advanced liver disease (11.4 vs. 6.4%, P=0.007). During the first year, Greeks more frequently had several tests and eventually a complete diagnosis (68 vs. 55%, P<0.001). Greeks were more frequently in the phase of HBeAg-negative CHB and less frequently in the phase of inactive carrier or HBeAg-positive CHB, but age was the main determinant for these differences in multivariate analysis. Treatment was initiated more frequently by Greeks than immigrants with treatment indications (86 vs. 65%, P<0.001). Only 30-33% of treated and 4-10% of untreated patients remained under follow-up at year 5, without significant differences between Greeks and immigrants.
  
  
  CONCLUSIONS
  Adherence to follow-up recommendations is rather poor for all chronic HBV patients. Immigrants are lost more frequently during the first year, but only small proportions of treated and particularly untreated Greek or immigrant patients remain under long-term follow-up.
authors.affiliation: Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Voulgaris
authors.forename: John
authors.initials: J
authors.lastname: Vlachogiannakos
authors.forename: Panagiota
authors.initials: P
authors.lastname: Ioannidou
authors.forename: Maria-Vasiliki
authors.initials: MV
authors.lastname: Papageorgiou
authors.forename: Evi
authors.initials: E
authors.lastname: Zampeli
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karagiannakis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Georgiou
authors.forename: Afroditi
authors.initials: A
authors.lastname: Papazoglou
authors.forename: George
authors.initials: G
authors.lastname: Karamanolis
authors.forename: George V
authors.initials: GV
authors.lastname: Papatheodoridis
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000639:trends; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005260:Female; D006115:Greece / Q000453:epidemiology; D019983:Guideline Adherence / Q000639:trends*; D054625:Healthcare Disparities / Q000208:ethnology / Q000639:trends*; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D053208:Kaplan-Meier Estimate; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance / Q000208:ethnology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006513:Hepatitis B e Antigens