Are physicians following guidelines? A survey of Hepatitis B management strategies

Lee, Keat Hong; Aung, Myat Oo; Lim, Seng Gee

doi:10.1007/s12072-012-9399-7

Cited by 5 publications

(12 citation statements)

References 19 publications

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“…In our study 51-69.8% questions related to decision of treatment in HBeAg negative patients were answered correctly. In a survey from Singapore, 11 25.4-42.5% participants choose to initiate the treatment outside the APASL recommendation which was comparable to our study (22.9-59.2%). In another study, 12 about 89.5% respondents recommend treatment in patients with high ALT level which was consistent with our results.…”

Section: Discussionsupporting

confidence: 86%

“…21 In the present study most of the physician preferred oral NAs (ETV or TDF) as first line therapy by choosing the efficacy, cost, safety and low resistance profiles as the most common reason of considering this treatment which were consistent with the other studies. 11,12 In a cross sectional survey from San Francisco, participants monitored ALT levels (79%) and HBV DNA levels (44%) every 6-12 months during CHB therapy. 16 Similar practices were reported in our study and our participants were using ALT and HBV DNA for monitoring but at the interval of 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…17 Additionally lower compliance rates with APASL recommendations regarding HBV treatment have been reported in two studies from Asia. 11,12 Moreover, 50% compliance with APASL recommendations for HBV treatment has been reported in one of these two studies. 11 However, no data is available from Pakistan regarding physician's practices in HBV management according to the guidelines.…”

mentioning

confidence: 83%

“…10 The treatment for HBV infection depends upon certain parameters including severity of fibrosis, serum HBV DNA and alanine transaminase (ALT) levels and HBeAg status. Significant variability in treatment of CHB among physicians have been reported in various studies from Singapore, 11 Hong Kong, 12 China, 13 Spain, 14 US 15,16 and Canada. 17 Additionally lower compliance rates with APASL recommendations regarding HBV treatment have been reported in two studies from Asia.…”

mentioning

confidence: 99%

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Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan

Hafeez¹,

Butt²,

Ahmed³

2018

Journal of Clinical and Experimental Hepatology

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Background: In Pakistan, approximately 4.5 million people are afflicted with chronic hepatitis B (CHB). The compliance with hepatitis B virus (HBV) management guidelines is still unknown. This was the first study from Pakistan in which the knowledge and practices of treating physicians were compared with three standardized guidelines (Asia Pacific Association for the Study of the Liver (APASL) 2012/European Association for the Study of the Liver (EASL) 2012/American Association for the Study of Liver Diseases (AASLD) 2009). Methods: A crosssectional study was conducted during 2014-2015 at four tertiary care teaching hospitals of Karachi, Pakistan. The study participants were internists, gastroenterologist, senior residents who were involved in the management of CHB patients. All participants were offered to fill the study questionnaire. Results: A total of 179 physicians (103 residents, 76 consultants) participated. Mean age of participant was 35 AE 9.3 years. Approximately one-third of them followed AASLD (27.3%) and EASL (24.0%) guidelines. Entecavir, tenofovir or Peg IFN 1 2a were considered as first line therapy by 43%, 38.5% and 30.2% respectively. However, 17.9% preferred entecavir with tenofovir for rescue therapy, 25.7% and 23.5% preferred tenofovir or entecavir as both first line and rescue therapy respectively. Serum HBV DNA, alanine transaminase levels were used to monitor during oral antivirals therapy by 45.3%. hepatocellular carcinoma screening was considered for all HBV cases by 51.4% using ultrasound (55.3%) and alfa fetoprotein (52.5%) every 6 months. Overall 40.2% participants had poor knowledge about indication of liver biopsy, treatment initiation and antiviral prophylaxis. Significant association was found between grades of knowledge and gender, age group, designation and specialty (P < 0.05). Younger physicians, consultants (age 25-40 years) and those who were practicing gastroenterology/hepatology were more likely to have higher knowledge scores in compliance with the guidelines as compared to others. Conclusion: Our study highlighted the gaps in knowledge and practices in managing CHB patients according to guidelines. Efforts to improve knowledge, refresher courses and appropriate coordination between gastroenterologists and internal medicine physicians could enable management and follow-up of patients with CHB effectively.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 83%

mentioning

confidence: 99%

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Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan

Hafeez¹,

Butt²,

Ahmed³

2018

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…Only cost of treatment was found to be statistically significant (indicated in bold). already difficult enough for doctors with considerable variation in management strategies [16], more so for patients without medical training to decide on their CHB treatment. Consequently, it is important to understand patient perspectives and preferences with regards to choice of therapy.…”

Section: Discussionmentioning

confidence: 99%