Chronic Liver Disease Management Among Primary Care Providers

Abstract

Introduction: The role of primary care providers (PCP) in the management of chronic liver diseases (CLD) is vital. Of the CLD guidelines that have been published, there is no clear mention which aspects of care are in the sphere of Gastroenterologist (GI) versus the PCP. The goal of this study was to analyze the care provided to CLD patients by PCPs in a residency program practice. Methods: This retrospective cohort study was performed on patients with diagnosis of Chronic Hepatitis C (HCV), Chronic Hepatitis B ( HBV) or liver cirrhosis, from three different practices. Patients that died or were not seen in the PCP office between January 2015 and April 2016 were excluded from the study. Implementation of commonly accepted American Association for the Study of Liver Diseases (AASLD) guidelines for the management of CLD was reviewed depending upon the diagnosis of the patient. Differences between PCP and PCP and GI co-managed cirrhosis patients were derived. Care provided to Hepatitis C patients and the impact of the type of insurance the patient had was analyzed. Results: 382 patients met Inclusion criteria. GI referral was provided in 76% (283/382) of patients. Follow up with GI was documented in 61% (174/382) of patients. Results regarding cirrhosis patients are summarized in Table 1. Chronic HCV was present in 278 patients. The percent of patient who received treatment for HCV was 41% (114/278), and 59% (164/278) did not receive treatment. Among HCV patients, 44% (81/183) of total private insurance patients received treatment while 52% (30/58) of total Medicare patients received treatment. Seventeen percent (3/18) of patients with no documented insurance at the time of our study were treated.Table 1: Results in Cirrhosis PatientsConclusion: Management of CLD patients by PCPs in our study group is suboptimal. Co-management with Gastroenterology does provide better patient care as demonstrated by higher compliance with immunization and screening guidelines. No significant difference was found between the treatments of HCV among different insurance plans. A large-scale study needs to be done to assess practice patterns among other residency practices and to figure out barrier to adherence to guidelines.