Conference Reports for NATAP

AASLD 60th Annual Meeting of the American Association for the Study of Liver Diseases Boston, MA, Hynes Convention Center October 30-November 3, 2009 Back

Diagnosis and Management of Chronic Hepatitis B in Asian-American Patients Among Primary Care Physicians in the United States       Reported by Jules Levin AASLD Oct 31-Nov 3 2009 Boston, MA, USA   Nimit Upadhyaya1, Daniel Salinas-Garcia1, Robert Chang1, Carol Davis1, Hong Tang1 1Bristol-Myers Squibb, Plainsboro, NJ, USA   SUMMARY Among the survey respondents, most primary care physicians (PCPs) consider CHB to be a serious disease   Despite awareness of the high prevalence of CHB among Asian-Americans, universal CHB screening of Asian-American patients is not practiced by the majority of responding physicians   The majority of CHB patients under respondent care are monitored without treatment. In general, there is low awareness of, and familiarity with, either of the current major CHB treatment guidelines   CONCLUSION More education among PCPs is needed regarding CHB disease progression and treatment   BACKGROUND Chronic hepatitis B (CHB) is a serious disease with potentially fatal consequences, such as from hepatocellular carcinoma (HCC) and cirrhosis, if left untreated1   In the United States, approximately 2 million people are estimated to be chronically infected with the hepatitis B virus1   CHB is more prevalent among Asian-Pacific Islanders (APIs), compared to the general population in the United States. Prevalence is estimated at 8.9% among foreign-born APIs, 1.4% among US-born APIs compared to 0.42% among non-Asians1   The majority (62%) of CHB diagnoses are made by primary care physicians (PCPs); however, the majority of CHB treatment (82%) is initiated by hepatologists and gastroenterologists2   Therefore, it is important to assess the level of CHB knowledge among PCPs and their role in CHB screening and disease management   OBJECTIVES The primary objective of this study is to assess the role of primary care physicians in CHB treatment by identifying their: - level of CHB knowledge - CHB patient load and management decisions - barriers and predictors of CHB diagnosis, treatment, and referral   METHODOLOGY   Participation criteria: - Primary care physicians (internal medicine, general practitioner, family practitioner) - See a minimum of 200+ patients per month - Have at least 5 CHB patients in their practice - Have practiced medicine at least 5 years - Practice full-time Geographic coverage within the United States: - New York/Northern New Jersey/Long Island - Los Angeles/Riverside/ Orange County - San Francisco/Oakland/ San Jose - Chicago/Gary/Kenosha - Houston/Galveston/Brazoria - Washington, DC/Baltimore - Seattle/Tacoma/Bremerton - Honolulu Questionnaire - A 35-minute structured questionnaire was directed to primary care physicians in relation to CHB. - The survey was conducted online between October to December 2008   RESULTS   Most primary care physicians considered CHB to be a serious disease that was prevalent in the Asian-American community   Universal CHB screening of Asian patients was not practiced by the majority of primary care physicians   Family history, signs of liver disease, and IV drug use were the main triggers to screen for CHB   On average, these PCPs monitored about half of their CHB patients without treating and treated about one-third with antiviral drugs   Internists treated a higher proportion of patients than general practitioners   REFERENCES 1. Cohen J, Evans AA, London WT, et al. Underestimation of chronic hepatitis B virus infection in the United States of America. Journal of Viral Hepatitis. 2007;15:12-13.   2. Synovate Monitor. Q1 2009.