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[Evaluation of the Rotterdam guideline for referral in case of chronic hepatitis B: improvement possible via a shortening of the referral chain and better distribution of information].

OBJECTIVE
Evaluation of the Rotterdam guideline for referring patients with chronic hepatitis B virus (HBV) infections from primary to specialist care for diagnosis and treatment.


DESIGN
Retrospective.


METHOD
Whether or not the guideline was followed correctly was determined in patients with chronic hepatitis B who were reported to the Municipal Health Service (GGD) in Rotterdam in 1998 and 1999. This was done by a study of their files and by questioning their general practitioners by phone.


RESULTS
During the study period, 376 cases of chronic hepatitis B were seen at the GGD; 32% of the patients dropped out during the referral trajectory. Drop-out took place at three different times: 13% during the process of deciding whether the patient should be referred according to the guideline, 12% during the consultation period at the GGD, and 7% after consultation at the GGD and before first contact with a specialist (via referral from the general practitioner). The reasons for dropping out were either procedural factors, such as missing information in the patient file and unclear management by the GGD, and personal factors such as failure of the general practitioner or the patient to comply with the recommendations.


CONCLUSION
The guideline for the referral of chronic hepatitis B patients functioned well but implementation can be improved, since some patients did not reach the specialist. Improvement would be made possible by shortening the referral chain and by giving more information to patients and general practitioners about hepatitis B and its potential consequences.