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

the ICARUS Study Group; Warshan K. Katwaroe; Sylvia M. Brakenhoff; Daniël P.C. van der Spek; Robert J. de Knegt; Laurens A. van Kleef; Robert A. de Man; Adriaan J.P. van der Meer; Milan J. Sonneveld

doi:10.3390/v14102229

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

the ICARUS Study Group, Warshan K. Katwaroe, Sylvia M. Brakenhoff, Daniël P.C. van der Spek, Robert J. de Knegt, Laurens A. van Kleef, Robert A. de Man, Adriaan J.P. van der Meer, Milan J. Sonneveld^*

^*Corresponding author for this work

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Abstract

Background and aims: Adherence to guidelines is associated with improved long-term outcomes in patients with chronic hepatitis B (CHB). We aimed to study the degree of adherence and determinants of non-adherence to management guidelines in a low endemic country. Methods: We reviewed the medical records of all CHB patients who visited our outpatient clinic in 2020. Adherence to guidelines was assessed based on predefined criteria based on the EASL guidance, and included the initiation of antiviral therapy when indicated, the optimal choice of antiviral therapy based on comorbidities, an assessment of HAV/HCV/HDV/HIV serostatus, renal function monitoring and enrolment in a HCC surveillance program if indicated. The adherence rates were compared across types of outpatient clinic (dedicated viral hepatitis clinic versus general hepatology clinic). Results: We enrolled 482 patients. Among the 276 patients with an indication for antiviral therapy, 268 (97.1%) received treatment. Among the patients with renal and/or bone disease, 26/29 (89.7%) received the optimal choice of antiviral agent. The assessment of HAV/HCV/HDV/HIV serostatus was performed in 86.1/91.7/94.4/78.4%. Among the 91 patients treated with tenofovir disoproxil, 57 (62.6%) underwent monitoring of renal function. Of the 241 patients with an indication for HCC surveillance, 212 (88.3%) were enrolled in a surveillance program. Clinics dedicated to viral hepatitis had superior adherence rates compared to general hepatology clinics (complete adherence rates 63.6% versus 37.2%, p < 0.001). Conclusions: Follow-up at a dedicated viral hepatitis clinic was associated with superior adherence to management guidelines.

Original language	English
Article number	2229
Journal	Viruses
Volume	14
Issue number	10
DOIs	https://doi.org/10.3390/v14102229
Publication status	Published - 11 Oct 2022

Bibliographical note

Funding Information:
The study was sponsored by the Foundation for Liver and Gastrointestinal Research (SLO), Rotterdam, the Netherlands. The project was financially supported by Gilead under grant number IN-NL-988-5952. Neither the SLO nor Gilead had any influence on the study design, data acquisition or analysis, nor the decision to submit for publication.

Publisher Copyright:
© 2022 by the authors.

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viruses-14-02229-v2Final published version, 251 KBLicence: CC BY

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title = "Assessment of Adherence to Clinical Guidelines in Patients with Chronic Hepatitis B",

abstract = "Background and aims: Adherence to guidelines is associated with improved long-term outcomes in patients with chronic hepatitis B (CHB). We aimed to study the degree of adherence and determinants of non-adherence to management guidelines in a low endemic country. Methods: We reviewed the medical records of all CHB patients who visited our outpatient clinic in 2020. Adherence to guidelines was assessed based on predefined criteria based on the EASL guidance, and included the initiation of antiviral therapy when indicated, the optimal choice of antiviral therapy based on comorbidities, an assessment of HAV/HCV/HDV/HIV serostatus, renal function monitoring and enrolment in a HCC surveillance program if indicated. The adherence rates were compared across types of outpatient clinic (dedicated viral hepatitis clinic versus general hepatology clinic). Results: We enrolled 482 patients. Among the 276 patients with an indication for antiviral therapy, 268 (97.1%) received treatment. Among the patients with renal and/or bone disease, 26/29 (89.7%) received the optimal choice of antiviral agent. The assessment of HAV/HCV/HDV/HIV serostatus was performed in 86.1/91.7/94.4/78.4%. Among the 91 patients treated with tenofovir disoproxil, 57 (62.6%) underwent monitoring of renal function. Of the 241 patients with an indication for HCC surveillance, 212 (88.3%) were enrolled in a surveillance program. Clinics dedicated to viral hepatitis had superior adherence rates compared to general hepatology clinics (complete adherence rates 63.6% versus 37.2%, p < 0.001). Conclusions: Follow-up at a dedicated viral hepatitis clinic was associated with superior adherence to management guidelines.",

author = "{the ICARUS Study Group} and Katwaroe, {Warshan K.} and Brakenhoff, {Sylvia M.} and {van der Spek}, {Dani{\"e}l P.C.} and {de Knegt}, {Robert J.} and {van Kleef}, {Laurens A.} and {de Man}, {Robert A.} and {van der Meer}, {Adriaan J.P.} and Sonneveld, {Milan J.}",

note = "Funding Information: The study was sponsored by the Foundation for Liver and Gastrointestinal Research (SLO), Rotterdam, the Netherlands. The project was financially supported by Gilead under grant number IN-NL-988-5952. Neither the SLO nor Gilead had any influence on the study design, data acquisition or analysis, nor the decision to submit for publication. Publisher Copyright: {\textcopyright} 2022 by the authors.",

year = "2022",

month = oct,

day = "11",

doi = "10.3390/v14102229",

language = "English",

volume = "14",

journal = "Viruses",

issn = "1999-4915",

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T1 - Assessment of Adherence to Clinical Guidelines in Patients with Chronic Hepatitis B

AU - the ICARUS Study Group

AU - Katwaroe, Warshan K.

AU - Brakenhoff, Sylvia M.

AU - van der Spek, Daniël P.C.

AU - de Knegt, Robert J.

AU - van Kleef, Laurens A.

AU - de Man, Robert A.

AU - van der Meer, Adriaan J.P.

AU - Sonneveld, Milan J.

N1 - Funding Information: The study was sponsored by the Foundation for Liver and Gastrointestinal Research (SLO), Rotterdam, the Netherlands. The project was financially supported by Gilead under grant number IN-NL-988-5952. Neither the SLO nor Gilead had any influence on the study design, data acquisition or analysis, nor the decision to submit for publication. Publisher Copyright: © 2022 by the authors.

PY - 2022/10/11

Y1 - 2022/10/11

N2 - Background and aims: Adherence to guidelines is associated with improved long-term outcomes in patients with chronic hepatitis B (CHB). We aimed to study the degree of adherence and determinants of non-adherence to management guidelines in a low endemic country. Methods: We reviewed the medical records of all CHB patients who visited our outpatient clinic in 2020. Adherence to guidelines was assessed based on predefined criteria based on the EASL guidance, and included the initiation of antiviral therapy when indicated, the optimal choice of antiviral therapy based on comorbidities, an assessment of HAV/HCV/HDV/HIV serostatus, renal function monitoring and enrolment in a HCC surveillance program if indicated. The adherence rates were compared across types of outpatient clinic (dedicated viral hepatitis clinic versus general hepatology clinic). Results: We enrolled 482 patients. Among the 276 patients with an indication for antiviral therapy, 268 (97.1%) received treatment. Among the patients with renal and/or bone disease, 26/29 (89.7%) received the optimal choice of antiviral agent. The assessment of HAV/HCV/HDV/HIV serostatus was performed in 86.1/91.7/94.4/78.4%. Among the 91 patients treated with tenofovir disoproxil, 57 (62.6%) underwent monitoring of renal function. Of the 241 patients with an indication for HCC surveillance, 212 (88.3%) were enrolled in a surveillance program. Clinics dedicated to viral hepatitis had superior adherence rates compared to general hepatology clinics (complete adherence rates 63.6% versus 37.2%, p < 0.001). Conclusions: Follow-up at a dedicated viral hepatitis clinic was associated with superior adherence to management guidelines.

AB - Background and aims: Adherence to guidelines is associated with improved long-term outcomes in patients with chronic hepatitis B (CHB). We aimed to study the degree of adherence and determinants of non-adherence to management guidelines in a low endemic country. Methods: We reviewed the medical records of all CHB patients who visited our outpatient clinic in 2020. Adherence to guidelines was assessed based on predefined criteria based on the EASL guidance, and included the initiation of antiviral therapy when indicated, the optimal choice of antiviral therapy based on comorbidities, an assessment of HAV/HCV/HDV/HIV serostatus, renal function monitoring and enrolment in a HCC surveillance program if indicated. The adherence rates were compared across types of outpatient clinic (dedicated viral hepatitis clinic versus general hepatology clinic). Results: We enrolled 482 patients. Among the 276 patients with an indication for antiviral therapy, 268 (97.1%) received treatment. Among the patients with renal and/or bone disease, 26/29 (89.7%) received the optimal choice of antiviral agent. The assessment of HAV/HCV/HDV/HIV serostatus was performed in 86.1/91.7/94.4/78.4%. Among the 91 patients treated with tenofovir disoproxil, 57 (62.6%) underwent monitoring of renal function. Of the 241 patients with an indication for HCC surveillance, 212 (88.3%) were enrolled in a surveillance program. Clinics dedicated to viral hepatitis had superior adherence rates compared to general hepatology clinics (complete adherence rates 63.6% versus 37.2%, p < 0.001). Conclusions: Follow-up at a dedicated viral hepatitis clinic was associated with superior adherence to management guidelines.

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DO - 10.3390/v14102229

M3 - Article

C2 - 36298784

AN - SCOPUS:85140753086

SN - 1999-4915

VL - 14

JO - Viruses

JF - Viruses

IS - 10

M1 - 2229

ER -

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

Abstract

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