Hofman R, Veldhuijzen Irene K, van der Lei Johan, Richardus Jan H
Erasmus MC, Instituut Maatschappelijke Gezondheidszorg, Rotterdam.
Contact: R. Hofman (
Ned Tijdschr Geneeskd. 2018 Jan 24;162:D2047.
To study the extent to which follow-up diagnostics, referral to secondary care and follow-up are in accordance with the practice guideline of the Dutch College of General Practitioners 'Viral hepatitis and other liver disorders' after a hepatitis B (HBV) or C (HCV) infection has been diagnosed at the general practice.
Retrospective cohort study.
Patient records were obtained from the Dutch 'Integrated primary care information' (IPCI) database which contains data from patients from general practices. Records of patients with a first-time positive HBsAg or anti-HCV test result in the period between 2008 and 2015 were manually validated and data on follow-up diagnostics, referral and follow-up were found.
A total of 117 patients tested positive for HBsAg and 101 patients tested positive for anti-HCV. Most HBV patients were subsequently tested for HBeAg (92%) and ALT (80%). Of the 41 HBV patients who were eligible for referral, 37 (90%) were actually referred to a specialist. 49 HCV patients (49%) were found negative after a confirmation or RNA test. 87% of the remaining 52 HCV patients were referred (n = 45). 21 (43%) of the 49 HBV patients who were not eligible for referral were tested for ALT after an average of 11.5 months. 14 (29%) of these patients subsequently received a second follow-up ALT test and 8 (16%) received a third.
Almost all HBV and HCV patients who are eligible for referral, are actually referred to a specialist. Most HBV patients received the correct follow-up diagnostics after a positive HbsAg test result. However, in few HBV patients who were not eligible for referral, was the ALT level checked every year for three years. The general practitioner, as well as the patient, should receive a reminder for this.
研究在全科医疗中诊断出乙型肝炎（HBV）或丙型肝炎（HCV）感染后，后续诊断、转诊至二级医疗以及随访是否符合荷兰全科医生学院“病毒性肝炎及其他肝脏疾病”实践指南。
回顾性队列研究。
从荷兰“综合初级医疗信息”（IPCI）数据库获取患者记录，该数据库包含来自全科医疗患者的数据。对2008年至2015年期间首次HBsAg或抗-HCV检测结果呈阳性的患者记录进行人工验证，并获取后续诊断、转诊和随访数据。
共有117例患者HBsAg检测呈阳性，101例患者抗-HCV检测呈阳性。大多数HBV患者随后接受了HBeAg检测（92%）和ALT检测（80%）。在41例符合转诊条件的HBV患者中，37例（90%）实际转诊至专科医生处。49例HCV患者在确认或RNA检测后结果为阴性。其余52例HCV患者中有87%（n = 45）被转诊。49例不符合转诊条件的HBV患者中有21例（43%）在平均11.5个月后接受了ALT检测。其中14例（29%）患者随后接受了第二次随访ALT检测，8例（16%）接受了第三次检测。
几乎所有符合转诊条件的HBV和HCV患者都实际转诊至专科医生处。大多数HBsAg检测结果呈阳性的HBV患者接受了正确的后续诊断。然而，少数不符合转诊条件的HBV患者在三年中每年都未检查ALT水平。对此应向全科医生以及患者发出提醒。
