Irving W L, Smith S, Cater R, Pugh S, Neal K R, Coupland C A C, Ryder S D, Thomson B J, Pringle M, Bicknell M, Hippisley-Cox J
Division of Microbiology and Infectious Diseases, School of Molecular Medical Sciences, University of Nottingham, UK.
J Viral Hepat. 2006 Apr;13(4):264-71. doi: 10.1111/j.1365-2893.2005.00698.x.
Management of hepatitis C virus (HCV)-infected individuals requires referral to specialist care. To determine whether patients newly diagnosed as anti-HCV positive are appropriately referred for further investigation and management, and if not, to determine why not. We studied patients tested for antibodies to HCV by Nottingham Public Health Laboratory in a 2-year period (2000-2002). The progress of newly diagnosed anti-HCV positive patients into specialist clinics for further management was documented. For patients not referred for specialist care, a questionnaire was sent to the clinician requesting the initial anti-HCV test, to identify reasons for nonreferral. Eleven thousand one hundred and seventy-seven patients were tested for anti-HCV. Two hundred and fifty-six (2.3%) were newly diagnosed as being anti-HCV positive. Two per cent of samples sent from primary care were anti-HCV positive, compared to 18.8, 18.9 and 1.3% sent from prison, drug and alcohol units, and secondary care, respectively. About 64.3% of positive patients diagnosed in primary care were referred to specialist care, compared to 18.4, 42.4 and 62.6% of patients diagnosed in the other three settings. One hundred and twenty-five (49%) newly diagnosed patients were referred appropriately for further management. 68 of these attended clinic, 45 underwent liver biopsy and 26 (10%) began treatment. One hundred and thirty-one patients (51%) were not referred. In 54 cases, there was no evidence that the anti-HCV positive result reached the patient. In 15, referral was considered but rejected, and 20 patients were referred to non-HCV-specialists (their general practitioners or to genito-urinary medicine). Hence less than 50% of newly diagnosed anti-HCV positive patients are referred to an appropriate clinic for further investigation and management. Reasons for this are multifarious and complex, reflecting both systems failure and patient choice. Unless these are understood and addressed, the Department of Health Hepatitis C Strategy (2002) and Action Plan for England (2004) will fail to achieve their intended objectives.
丙型肝炎病毒（HCV）感染个体的管理需要转诊至专科护理。为了确定新诊断为抗-HCV阳性的患者是否被适当地转诊以进行进一步的调查和管理，如果没有，确定原因。我们研究了诺丁汉公共卫生实验室在两年期间（2000 - 2002年）检测HCV抗体的患者。记录了新诊断为抗-HCV阳性的患者进入专科诊所进行进一步管理的进展情况。对于未转诊至专科护理的患者，向最初进行抗-HCV检测的临床医生发送了一份问卷，以确定未转诊的原因。11177名患者接受了抗-HCV检测。256名（2.3%）新诊断为抗-HCV阳性。从初级保健机构送检的样本中有2%抗-HCV阳性，相比之下，从监狱、戒毒和戒酒单位以及二级保健机构送检的样本中抗-HCV阳性率分别为18.8%、18.9%和1.3%。在初级保健机构诊断出的阳性患者中，约64.3%被转诊至专科护理，相比之下，在其他三种情况下诊断出的患者中这一比例分别为18.4%、42.4%和62.6%。125名（49%）新诊断患者被适当地转诊以进行进一步管理。其中68人就诊，45人接受了肝活检，26人（10%）开始治疗。131名患者（51%）未被转诊。在54例中，没有证据表明抗-HCV阳性结果告知了患者。在15例中，曾考虑转诊但被拒绝，20名患者被转诊至非HCV专科医生（他们的全科医生或泌尿生殖医学医生）。因此，不到50%的新诊断为抗-HCV阳性的患者被转诊至合适的诊所进行进一步的调查和管理。原因多种多样且复杂，既反映了系统故障，也反映了患者的选择。除非理解并解决这些问题，否则卫生部的丙型肝炎战略（2002年）和英格兰行动计划（2004年）将无法实现其预期目标。
