<p>Management of Hepatitis B Surface Antigen and Hepatitis C Antibody-Positive Patients by Departments Not Specializing in Hepatology at a Suburban University Hospital in Japan: A Single-Center Observational Study</p>

Abstract

To investigate effects of an altered medical environment between 2010 and 2015 on viral hepatitis treatment behaviors of doctors who were not hepatology specialists. Methods: Charts of patients who were identified as hepatitis B surface antigen (HBs-Ag)positive or hepatitis C virus antibody (HCV-Ab)-positive by university hospital departments not specializing in hepatology from January to December 2015 were retrospectively reviewed. Patients were assigned to a "referred" group or a "non-referred" group based on whether they were subsequently referred to the Hepatology Department. Age, sex, type of department visited (one of various internal medicine departments, or a different department), and blood test results were compared in the two groups. Results: Among 7,824 patients screened for HBs-Ag, 82 were positive. Twenty-nine (35.4%) had subsequently been referred to the Hepatology Department, which was higher than the 2010 referral rate (20.6%). In multivariate analysis, patients in the referred group were significantly more likely to have visited one of various internal medicine departments, and they had higher levels of platelet count and γ-glutamyl transpeptidase. Among 7,778 patients screened for HCV-Ab, 279 were positive. Only 33 (11.8%) had subsequently been referred to the Hepatology Department, which was lower than the 2010 referral rate (18.7%). In multivariate analysis, patients in the referred group were significantly more likely to have visited an internal medicine department. Conclusion: HCV-antibody-positive patients screened by departments not specializing in hepatology were not managed adequately in 2015. This suggests a need for education of doctors not specializing in hepatology, particularly those not working in internal medicine departments.

Retrieval of lost patients in the system for hepatitis C microelimination: a single-center retrospective study

“…Despite that HCV antibody–positive patients clearly need HCV testing or treatment, Fujii [ 10 ] reported the lack of intrahospital collaboration even in medical institutions with hepatologists. Only 12% of probable HCV-positive patients were referred to specialists [ 11 ], and the majority were lost to follow-up; thus, they did not receive the subsequent therapy. Given that these new DAAs have been reimbursed by Taiwan health system since 2017 and the government set a goal of 80% treatment coverage rate with DAAs by 2025 in Taiwan [ 12 ], our hospital organized the “Retrieval of Lost Patients of the Hospital” strategy in 2020, aimed to eliminate HCV infection in the hospital by searching first for patients with a history of HCV infection who were lost to follow-up.…”