The Rate of Referral of Hepatitis Virus Carriers to Hepatologists and the Factors Contributing to Referral

Intern Med. 2017;56(15):1943-1948. doi: 10.2169/internalmedicine.56.8249. Epub 2017 Aug 1.

Abstract

Objective The aims of the present study were to determine the proportions of hepatitis B surface antigen (HBsAg)-positive and anti-hepatitis C virus (HCV)-positive patients, and identify the characteristics that influenced referral to a hepatologist. Methods The present study included patients who were positive for HBsAg (n=153) or anti-HCV (n=574); their viral status was tested by non-hepatologists between January 2008 to December 2012. We performed a multivariate analysis to investigate the factors associated with the referral of patients to hepatologists. Results The rates of hepatitis B virus (HBV) and the percentage of suspected HCV carriers at the hospital were 1.4% and 3.5%, respectively. Among the 727 patients who were seropositive for HBV or HCV, 107 (14.7%) were referred to a hepatologist. A multivariate analysis to investigate the factors contributing to referral revealed that (i) an alanine aminotransferase (ALT) level of >30 IU/L [odds ratio (OR), 3.24; 95% confidence interval (CI), 2.10-5.03; p<0.001]; (ii) undergoing testing at an internal medicine department (OR, 2.79; 95% CI, 1.80-4.38; p<0.001); and (iii) HBsAg-positivity (OR, 2.22; 95% CI, 1.35-3.61; p=0.002) were factors that significantly influenced referral. Conclusion Hepatologists must educate non-hepatologists, especially non-internists, to promote the referral of hepatitis-virus carriers, especially HCV carriers, even in patients with ALT levels of <30 IU/L.

Keywords: HBV; HCV; hepatitis virus carriers; medical collaboration; non-hepatologist.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alanine Transaminase
  • Carrier State
  • Female
  • Gastroenterologists
  • Hepatitis B / diagnosis*
  • Hepatitis B / immunology
  • Hepatitis B / therapy*
  • Hepatitis B Surface Antigens / immunology
  • Hepatitis B virus / immunology
  • Hepatitis C / diagnosis*
  • Hepatitis C / immunology
  • Hepatitis C / therapy*
  • Humans
  • Male
  • Middle Aged
  • Referral and Consultation / statistics & numerical data*
  • Young Adult

Substances

  • Hepatitis B Surface Antigens
  • Alanine Transaminase