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Effective
Treatment Does Not Reach HBV Patients in the Netherlands Due to Lack of
Use by Specialists of Treatment Guidelines In a prior study, the authors of the current study (University of Amsterdam and the University Medical Center in Rotterdam, The Netherlands) described that only 30% of chronic HBV patients with active disease (HBeAg(+) or elevated ALT) identified by the primary care physician receive specialist care (Journal of Hepatology 2004;41:1026-1030). To standardize and improve HBV treatment in specialist care, HBV treatment guidelines have been developed. Their impact on specialist care was evaluated. A questionnaire was sent to all gastroenterologists and
infectious disease specialists in the Approximately half of the physicians (52%) saw a few patients a year, 36% a couple a month and 12% saw patients at least weekly. Most (70%) prescribe antiviral treatment themselves, increasing from 54% for doctors seeing only a few patients a year to 90% for those seeing more patients. Physicians who do not prescribe treatment refer in only 62% of cases to a specialized centre. Less than half (46%) of the physicians seeing patients work according a protocol. However, 72% express a need for a standardized protocol, independently of the amount of patients seen, ranging from 50% for those seeing many patients, increasing to 94% for those seeing a few patients a month, which suggests that availability of protocols could be a problem. Of those treating patients, only 44% has ever used a nucleoside/nucleotide analogue (NUC), which use increases from 18% for those seeing only a few patients a year to 78% seeing patients more frequently. In addition, among those treating patients but not using NUC, 72% do not refer to a specialized center. The majority (61%) prescribing NUC do not perform mutation analysis during treatment, although 91% (p<0.001) has access to these tests. The use of a protocol does not imply that physicians treat patients themselves or use nucleoside analogues more often. However among the specialists using a protocol, the access to the standard laboratory tests (HBV DNA) and specialized tests (resistance, genotype) is higher and resistance testing is performed more often, suggesting that monitoring is improved. But there still is a reluctance to initiate treatment. In conclusion, the authors write, “The more patients [that] specialists see, the more likely they will treat these patients themselves. About one third of the physicians do not refer. Despite [this], they do not treat patients and therefore deprive them of treatment.” “Only 44% of the specialists ever used a NUC and most of them do not refer, leaving [for example], interferon failures devoid of NUC treatment.” “In the development of HBV treatment guidelines more attention should be given to implementation of the [treatment] guidelines especially with regard to initiation of treatment.” 11/16/05 Reference
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