Clinical audit of quality of care among patients with viral hepatitis in primary care in a low endemic region

Abstract

Background The current hepatitis B (HBV) and hepatitis C virus (HCV) screening practices may fail to detect many infected patients who could benefit from new therapeutic agents to limit progression to cirrhosis and hepatocellular carcinoma.Objectives This study assessed the test positivity rate and cascade of care of viral hepatitis patients in primary care in a low endemic region as well as the testing policy of abnormal alanine aminotransferase (ALT) level.Methods This is a retrospective clinical audit among primary health care practices in Flanders, Belgium, assessing patients with an active medical file between 2019 and 2021.Results A total of 84/89 (94.4%) primary health care practices participated representing 621,573 patients of which 1069 patients (0.17%) were registered as having viral hepatitis, not further specified. Detailed information was available from 38 practices representing 243,723/621,573 (39.2%) patients of which 169 (0.07%) were HBsAg positive and 99 (0.04%) anti-HCV positive. A total of 96/134(71.6%) chronic HBV-infected and 31/77(40.3%) chronic HCV-infected patients were referred to a hepatologist. A total of 30,573/621,573(4.9%) patients had an abnormal ALT level, and by at random selection, more detailed information was obtained on 211 patients. Information on high-risk groups was missing in up to 60%. In patients with abnormal ALT level, HBsAg and anti-HCV testing were conducted in 37/211(17.5%) and 25/211(11.8%), respectively.Conclusion In a low endemic region, the testing rate and cascade of care of HBV and HCV-infected patients can be improved in primary care, especially in high-risk groups and patients with abnormal ALT levels. Infections with the hepatitis B virus (HBV) and hepatitis C virus (HCV) are a leading cause of death worldwide. Over the last decade, several new therapeutic agents have been developed and can now prevent hepatitis-related deaths. Awareness and increasing testing rates for viral hepatitis in primary care could therefore contribute to control these diseases. The findings of our clinical audit among primary health care practices in Flanders, Belgium demonstrate that screening for HBV and HCV infection can be improved in primary health care in a low endemic region, especially in high-risk groups (e.g. migrants who originate from an endemic country) and patients with abnormal ALT level. The observed suboptimal testing rate in primary health care may be due to a lack of information on risk groups. Future research should focus on interventions to enhance testing, linkage to care, and treatment initiation for HBV and HCV infection among well-defined risk groups in primary health care.