Epidemiology and management of hepatitis B and C in primary care in the Netherlands: data from the Rijnmond Primary Care database

Abstract

Background The Dutch guideline for general practitioners (GPs) advises biannual surveillance of hepatitis B (HBV) patients and referral of every hepatitis C (HCV) patient. We aimed to study the prevalence, incidence, and the management of hepatitis B and C in primary care. Methods This is a retrospective cohort study using the Rijnmond Primary Care database (RPCD), including health care data of medical records of GPs of approximately 200,000 patients in the area of Rotterdam, the Netherlands. Patient records were selected based on laboratory results, International Classification of Primary Care (ICPC) codes, and free-text words. Results In total, 977 patients were included: 717 HBV, 252 HCV, and 8 HBV/HCV coinfected patients. Between 2013 and 2019, the prevalence of HBV and HCV declined from 5.21 to 2.99/1,000 person-years (PYs) and 1.50 to 0.70/1,000 PYs, respectively. We observed that the majority of the patients had been referred to a medical specialist at least once (71% HBV and 89% HCV patients). However, among chronic patients, we observed that 36.2% of the HBV patients did not receive adequate surveillance by their GP (≥2 alanine aminotransferase checks within 3 years) or a medical specialist. In addition, 44.4% of the HCV patients had no record about successful antiviral treatment. Conclusions This study demonstrated a declining prevalence in viral hepatitis B and C in primary care in the Netherlands. However, a substantial part of the patients did not receive adequate surveillance or antiviral therapy. It is therefore crucial to involve GPs in case finding and in follow-up after treatment.

Assessment of Adherence to Clinical Guidelines in Patients with Chronic Hepatitis B

“…The findings reported here corroborate those from a previous study [ 13 ] and are in line with reports from other fields [ 14 , 15 , 16 ]. Furthermore, we have recently published a study showing that general practitioners generally do not provide adequate follow-up to patients with viral hepatitis, despite the availability of a specific guideline [ 17 ], further underscoring the importance of centralizing care in CHB. Additional interventions that could potentially improve adherence are focused on training sessions and/or the implementation of tools in the electronic medical records that support standardised care, for example, through reflex testing for co-infections in patients with viral hepatitis.…”