Identifying Patient and Provider-specific Gaps in Care Among Patients With Hepatitis B

Kushner, Tatyana; Lam, Robert L.; Gray, Daniel; Kaplan, David E.; Serper, Marina

doi:10.1097/mcg.0000000000000806

Cited by 5 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Efforts focusing on HBV, HCV and NAFLD prevention and treatment should prioritise populations that are most affected by economic, language or geography barriers. [360][361][362] CONCLUSIONS Despite great progress in our understanding of factors that contribute to racial/ethnic disparities in cancer incidence, tumour biology and outcomes, disparities still exist, and multidisciplinary efforts are needed to ameliorate or eliminate them (Box 2).…”

Section: Disparities In Liver Cancermentioning

confidence: 99%

Cancer health disparities in racial/ethnic minorities in the United States

et al. 2020

View full text Add to dashboard Cite

There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA—African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.

show abstract

Section: Disparities In Liver Cancermentioning

confidence: 99%

Cancer health disparities in racial/ethnic minorities in the United States

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Among process measures, testing for HDV infection, performed in 35% of individuals, was the only measure that remained strongly associated with improved survival after multivariable adjustment. It is extremely unlikely that identification of HDV resulted in survival improvements, because HDV co‐infection rates in this population are relatively low, 18 and there was no highly effective therapy for HDV available during the study period. We postulate that HDV testing represents a surrogate marker for high‐quality HBV care by practitioners with significant expertise in viral hepatitis and possibly testing adherence behaviours by highly compliant patients.…”

Section: Discussionmentioning

confidence: 99%

“…We and others have identified low adherence with recommended laboratory testing and significant gaps in the clinical recognition of HBV diagnosis and subsequent follow‐up care 10‐13,18,39 . In the VA system, there appears to have been significant temporal improvements with regard to referral to specialists, documentation of chronic infection in the problem list, HBeAg and HBV‐DNA testing, testing for concomitant HIV, receipt of initial imaging and appropriate HBV antiviral therapy initiation.…”

Section: Discussionmentioning

confidence: 99%

“…We previously demonstrated overall low adherence to HBV care quality measures in the Veterans Affairs (VA) healthcare system and showed that patients receiving specialty care had a higher frequency of recommended laboratory testing, higher receipt of appropriate antiviral therapy and greater adherence with liver cancer surveillance 10 . In follow‐up work, we found that patient engagement with primary care services was associated with improved rates of attending visits with HBV specialists, while severe psychiatric disease was a significant barrier 18 …”

Section: Introductionmentioning

confidence: 95%

See 1 more Smart Citation

Care quality and outcomes among US veterans with chronic hepatitis B in the hepatitis C direct‐acting antiviral era

Kaplan

Medvedeva

Serper

2020

Journal of Viral Hepatitis

Self Cite

View full text Add to dashboard Cite

Adherence to guideline‐recommended hepatitis B virus (HBV) care is suboptimal. We hypothesized that national hepatitis C eradication efforts during the era from 2015 to 2017 would improve the quality of care for cHBV given increased recognition and specialty referrals for liver disease. The study described herein is a retrospective cohort study of veterans with at least one positive HBsAg (HBsAg+) result from 1 January 2003 to 31 December 2017 using the VA Corporate Data Warehouse (CDW) analysed by era (2003‐2004, 2005‐2009, 2010‐2014, 2015‐2017). Relevant covariates such as HCV co‐infection, demographics, cirrhosis and baseline laboratory testing were obtained through previously validated approaches. We evaluated completion of process measures within 2 years of the index HBsAg + result: specialty care referral; testing of ALT, HBV‐DNA, HBeAg and anti‐HBe; testing for co‐infection and/or vaccination for HAV, HCV, HDV and HIV; and hepatocellular carcinoma (HCC) surveillance among those meeting criteria. We also measured use of antiviral therapy in appropriate candidates (ALT ≥ 2 × ULN, HBV‐DNA ≥ 2000 IU/mL). Of the 16 673 individuals with HBsAg + test results, 9,521 were confirmed as chronic HBV. Era‐related (Era 3:2010‐2014 vs Era 4:2015‐2017) increases in guideline‐recommended process measures included the following: outpatient visits with GI/ID specialists (78%‐89%), HBV‐DNA testing (73%‐79%), HDV testing (27%‐35%), appropriate HBV antiviral utilization (55%‐70%) and HCC surveillance (40%‐43%); all P < .0001. In the subset of HBV/HCV‐co‐infected patients, HCV DAA therapy was associated with a trend towards improved overall survival. In conclusion, the overall quality of care for HBV has significantly improved in the era of widespread HCV DAA therapy in an integrated health system possibly due to increased recognition and referral for liver disease.

show abstract

“…In the current study, the monitoring rate of chronic HBV infection was low, and patients had poor adherence to long-term monitoring and HCC surveillance. A series of retrospective studies demonstrated that the monitored rate every year was 50-70% for ALT and 15-40% for HBV-DNA [12][13][14][15]; One metaanalysis reported that the overall adherence rate to HCC surveillance was suboptimal at 52% [16]. It could be attributed to the lack of disease knowledge, no follow-up management rules, fragmented services, health care costs, social discrimination, transportation, and scheduling process di culties [16-18].…”

Section: Discussionmentioning

confidence: 99%

Long-term monitoring, and hepatocellular carcinoma surveillance in patients with chronic hepatitis B infection

Huang

Yang

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Guidelines reported that the patients infected with hepatitis B (HBV) need monitoring of disease progression and hepatocellular carcinoma (HCC) screening to reduce the risk of decompensated cirrhosis and HCC. The present study aimed to examine the rates and risk factors of adherence to guideline-recommended long-term monitoring and HCC surveillance in patients with chronic hepatitis B Virus (CHB) infection. Methods: We performed a retrospective study of outpatients with CHB infection who from the outpatient database of a Chinese hospital in 2018 by using the International Classification of Diseases revision 10 code and computer queries. The guideline-recommended long-term monitoring and HCC surveillance require to monitor ≥2 times during the2-year follow-up period. Results: We analyzed 402 eligible outpatients with CHB infection. The number and rates of guideline-recommended long-term monitoring and HCC surveillance annually were as follows: 171 (42.54%) for alanine aminotransferase (ALT) and hepatitis B virus DNA (HBV-DNA), 107 (26.62%) for HCC surveillance, and 103 (25.62%) for all examinations which including ALT, HBV-DNA, and HCC surveillance. Age (P=0.018), gender (P=0.010), outpatient visit times (P=0.036), and antiviral treatment (P=0.044) were associated with the guideline-recommended long-term monitoring of ALT and HBV-DNA. Antiviral treatment (P=0.003, P=0.002) and initial liver imaging (P<0.001, P<0.001) were associated with the guideline-recommended HCC surveillance and also the monitoring of all examination. Conclusions: The present study observed poor adherence to the guideline-recommended long-term monitoring and HCC surveillance in patients with CHB infection. Additional measures are needed to promote disease monitoring and achieve optimal HBV management.

show abstract

Identifying Patient and Provider-specific Gaps in Care Among Patients With Hepatitis B

Abstract: In a diverse cohort of veterans with high psychiatric comorbidity and substance abuse, important patient and provider factors influence appropriate follow-up care. Future studies should evaluate the impact of provider education and care coordination strategies in HBV.

Cited by 5 publications

References 28 publications

Cancer health disparities in racial/ethnic minorities in the United States

Cancer health disparities in racial/ethnic minorities in the United States

Care quality and outcomes among US veterans with chronic hepatitis B in the hepatitis C direct‐acting antiviral era

Long-term monitoring, and hepatocellular carcinoma surveillance in patients with chronic hepatitis B infection

Contact Info

Product

Resources

About