Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Fam Pract. 2023 Feb 9;40(1):83-90. doi: 10.1093/fampra/cmac070.
The Dutch guideline for general practitioners (GPs) advises biannual surveillance of hepatitis B (HBV) patients and referral of every hepatitis C (HCV) patient. We aimed to study the prevalence, incidence, and the management of hepatitis B and C in primary care.
This is a retrospective cohort study using the Rijnmond Primary Care database (RPCD), including health care data of medical records of GPs of approximately 200,000 patients in the area of Rotterdam, the Netherlands. Patient records were selected based on laboratory results, International Classification of Primary Care (ICPC) codes, and free-text words.
In total, 977 patients were included: 717 HBV, 252 HCV, and 8 HBV/HCV coinfected patients. Between 2013 and 2019, the prevalence of HBV and HCV declined from 5.21 to 2.99/1,000 person-years (PYs) and 1.50 to 0.70/1,000 PYs, respectively. We observed that the majority of the patients had been referred to a medical specialist at least once (71% HBV and 89% HCV patients). However, among chronic patients, we observed that 36.2% of the HBV patients did not receive adequate surveillance by their GP (≥2 alanine aminotransferase checks within 3 years) or a medical specialist. In addition, 44.4% of the HCV patients had no record about successful antiviral treatment.
This study demonstrated a declining prevalence in viral hepatitis B and C in primary care in the Netherlands. However, a substantial part of the patients did not receive adequate surveillance or antiviral therapy. It is therefore crucial to involve GPs in case finding and in follow-up after treatment.
荷兰全科医生（GP）指南建议每半年监测一次乙型肝炎（HBV）患者，每例丙型肝炎（HCV）患者都应转诊。我们旨在研究初级保健中乙型肝炎和丙型肝炎的流行率、发病率和管理情况。
这是一项回顾性队列研究，使用 Rijnmond 初级保健数据库（RPCD），该数据库包含荷兰鹿特丹地区约 20 万患者的医疗记录的医疗保健数据。根据实验室结果、国际初级保健分类（ICPC）代码和自由文本词选择患者记录。
共纳入 977 例患者：717 例 HBV、252 例 HCV 和 8 例 HBV/HCV 合并感染患者。2013 年至 2019 年间，HBV 和 HCV 的患病率从 5.21 降至 2.99/1000人年（PYs）和 1.50 降至 0.70/1000 PYs。我们观察到，大多数患者至少接受过一次专科医生转诊（71%的 HBV 和 89%的 HCV 患者）。然而，在慢性患者中，我们观察到 36.2%的 HBV 患者未接受其 GP（3 年内至少进行 2 次丙氨酸氨基转移酶检查）或专科医生的充分监测。此外，44.4%的 HCV 患者没有记录成功的抗病毒治疗。
本研究表明，荷兰初级保健中乙型肝炎和丙型肝炎的流行率呈下降趋势。然而，相当一部分患者未接受充分的监测或抗病毒治疗。因此，让全科医生参与病例发现和治疗后随访至关重要。
