European Journal of Gastroenterology and Hepatology
Volume 29, Issue 3, 2017, Pages 264-270

Adherence to follow-up and treatment recommendations in Greek and immigrant patients with chronic hepatitis B in Greece (Article)

Voulgaris T. , Vlachogiannakos J. , Ioannidou P. , Papageorgiou M.-V. , Zampeli E. , Karagiannakis D. , Georgiou A. , Papazoglou A. , Karamanolis G. , Papatheodoridis G.V.*
  • a Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • b Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • c Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • d Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • e Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • f Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • g Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • h Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • i Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece
  • j Academic Department of Gastroenterology, Medical School of National, Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 115 27, Greece

Abstract

Background/Aim Immigrants have multiple barriers to access to health care systems. We evaluated the adherence to follow-up and treatment recommendations of chronic hepatitis B virus (HBV) Greek and immigrant patients. Methods In total, 1001 consecutive adult patients with chronic HBV infection who visited our clinics for the first time between 2002 and 2011 were included. All patients born outside Greece were considered immigrants. Diagnosis was considered to be complete if patients could be classified into HBeAg-positive chronic hepatitis B (CHB), inactive carriers, HBeAg-negative CHB, or decompensated cirrhosis. Results Of the patients, 56% were Greeks and 44% were immigrants. Greeks visited our clinics at a significantly older mean age (50 vs. 35 years, P<0.001) and more frequently with advanced liver disease (11.4 vs. 6.4%, P=0.007). During the first year, Greeks more frequently had several tests and eventually a complete diagnosis (68 vs. 55%, P<0.001). Greeks were more frequently in the phase of HBeAg-negative CHB and less frequently in the phase of inactive carrier or HBeAg-positive CHB, but age was the main determinant for these differences in multivariate analysis. Treatment was initiated more frequently by Greeks than immigrants with treatment indications (86 vs. 65%, P<0.001). Only 30-33% of treated and 4-10% of untreated patients remained under follow-up at year 5, without significant differences between Greeks and immigrants. Conclusion Adherence to follow-up recommendations is rather poor for all chronic HBV patients. Immigrants are lost more frequently during the first year, but only small proportions of treated and particularly untreated Greek or immigrant patients remain under long-term follow-up. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Author Keywords

Greek Immigrant Follow-up adherence Hepatitis B

Index Keywords

immigrant Kaplan-Meier Estimate follow up human epidemiology Antiviral Agents middle aged Odds Ratio trends Practice Guidelines as Topic protocol compliance controlled study Biomarkers time factor priority journal Guideline Adherence Time Factors disease carrier clinical practice comparative study liver disease ethnology Humans migrant treatment indication Treatment Outcome chi square distribution male Chi-Square Distribution Emigrants and Immigrants female risk factor Multivariate Analysis Risk Factors Greece Hepatitis B e Antigens Article Retrospective Studies blood patient compliance major clinical study adult Hepatitis B, Chronic migration peginterferon alpha biological marker Practice Patterns, Physicians' ambulatory care chronic hepatitis B Emigration and Immigration antiviral therapy retrospective study decompensated liver cirrhosis Healthcare Disparities practice guideline health care disparity Kaplan Meier method hepatitis B(e) antigen Lost to Follow-Up antivirus agent
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85001969745&doi=10.1097%2fMEG.0000000000000788&partnerID=40&md5=f4289ef0370fe8dadaef1364086a57b6
DOI: 10.1097/MEG.0000000000000788
ISSN: 0954691X
Cited by: 1
Original Language: English