[Waiting time for and length of physicianc's consultation define the patient-physician interaction: results of a prospective study in 478 patients with chronic viral hepatitis]. / Wartezeiten und Länge des Arztgesprächs bestimmen aus Patientensicht die Qualität der Arzt-Patienten-Beziehung bei chronischer Hepatitis B und C: Ergebnisse einer prospektiven Studie bei 478 Patienten mit chronischer Virushepatitis.

BACKGROUND: Little is known about the physician-patient interaction in hepatitis B and C. METHODS: This study by the federal competence network hepatitis analysed the physician-patient interaction using the validated FAPI questionnaire. The questionnaire also contained questions concerning demography and disease characteristics. Of the total 1500 questionnaires sent out, 478 were returned (32 %) (20 % HBV vs. 80 % HCV). RESULTS: The FAPI index of patients with HBV/HCV infection (3.10 +/- 0,99) was lower than that in patients with other internal medicine diseases (3.61 +/- 0.92; n = 148). Women had lower values than men (2.98 vs. 3.25; p = 0.005). Patients with active HBV infection showed higher values than those with HCV infection (3.27 vs. 2.97; p < 0.05). Patients with successfully treated hepatitis B/C had higher values than those with active disease (3.36 vs. 3.02; p = 0.004). The index was lower in patients who waited > 2 weeks for the consultation when compared to those with a shorter wait (2.92 vs. 3.31; p < 0.001) and was also lower in patients who waited > 30 min at the consultation day when compared to those with a shorter wait (2.81 vs. 3.39; p < 0.001). The index gradually increased with the consultation length (2.47 < 10 min vs. 2.79 10 - 15 min vs. 3.21 15 - 30 min vs. 3.82 > 30 min; p < 0.001). The index was higher in patients seen by gastroenterologists (3.43) when compared with general practioners (3.10), internists (3.02) and clinical settings (3.13) (p < 0.05). A good information status was associated with higher FAPI values when compared with a bad information status (3.43 vs. 2.76; p < 0.001). Fibrosis, health insurance and age were not associated with FAPI index (p > 0.2). By multivariate analysis a long consultation, a good information status, patients' patience, short waiting times, and providing contact to a patient support group were independently associated with a high index. CONCLUSIONS: The physician-patient interaction in chronic viral hepatitis is worse than in other internal medicine diseases with problems being more pronounced in HCV infection and women when compared to men and HBV infection. Short waiting times and patients' patience ameliorated the interaction as well as the consultation length, the information status of the patient and providing contact to a patient support group. Type of health insurance did not affect either waiting times or physician-patient interaction; thus there is no hint for a two-class medicine in this part of hepatology.

[Changes in socio-economics, quality of life and knowledge of patients with chronic hepatitis C during the Hepatitis Competence Net Project]. / Entwicklung von sozioökonomischen Charakteristika, Lebensqualität und Wissensstand bei Patienten mit Hepatitis C während des Projektes Kompetenznetz Hepatitis.

AIMS AND METHODS: The study of the Patient Support Group Deutsche Leberhilfe e.V. and the Federal Hepatitis Competence Net prospectively analysed questionnaires about quality of life (SF12) and socio-economical data of patients with chronic hepatitis C (CHC). A 1st questionnaire 3 1/2 years ago gathered information in 714 CHC patients all of whom now received a 2nd questionnaire which was sent back by 503 subjects (71%). RESULTS: Both mental and physical SF 12 scores remained markedly decreased compared with scores for the general population which approximate 50 points (p<0.001). When compared to values obtained 3S years ago, mental scores increased from 41.2 to 42.5 and physical scores from 41.9 to 42.9 (changes not significant by analysis of variance; p>0.05). However, in patients with negative HCV-RNA, physical and mental scores significantly increased by 6.9 and 4.0 points (p<0.01). In contrast, mental and physical scores decreased by 2.4 and 2.5 points during follow-up in patients with fibrosis (Metavir F2-4) (p<0.05). SF 12-scores closely correlated with degrees of inflammation and fibrosis (p<0.001, respectively). Quality of life was associated with socio-economical data and gradually increased with higher school graduation. A high percentage of patients with CHC were unemployed (18%); of patients aged 65 years, 25% were already retired; 60% of the retired subjects received a disability pension, 37% because of CHC. Unemployed patients had lower SF 12 scores than patients with a job. Subjects with public employers had significantly lower SF 12 scores than privately or self-employed subjects. Complications of CHC markedly reduced SF 12 scores. Just 37% of subjects had a life insurance and only 9% had an insurance of occupational invalidity (values 2-3-times lower than those in the general German population). Insurance applications for life and occupational invalidity had been denied in 17 and 53%, respectively; the denial values were even higher than in the 1st questionnaire. CONCLUSIONS: The prospective follow-up shows that quality of life continuously improves after elimination of HCV, whereas mental and physical health get increasingly worse with ongoing fibrosis. The analysis demonstrates that many CHC subjects have severe socio-economical problems leading to unemployment, early retirement and lack of appropriate insurances. These problems further reduce the quality of life in CHC.

[Socioeconomic characteristics, quality of life, and state of knowledge of patients with hepatitis C viral infection in Germany--socioeconomic aspects in hepatitis C]. / Sozio-ökonomische Charakteristika, Lebensqualität und Wissensstand bei Patienten mit Hepatitis-C-Virusinfektion in Deutschland--Sozio-ökonomische Aspekte bei Hepatitis C.

BACKGROUND: Little is known as yet about the socio-economic consequences for patients with hepatitis C in Germany. AIMS AND METHODS: The study of the Deutsche Leberhilfe e. V., supported by the federal hepatitis competence net, prospectively analyzed questionnaires about quality-of-life, education and work situation, insurance, and various other socio-economical aspects of patients with chronic hepatitis C. The questionnaire included questions about the information status of patients concerning hepatitis C in general and their individual disease. Overall, 1500 questionnaires were distributed by clinics, general practitioners, patient-support groups and via the internet; 714 were sent back and analyzed. RESULTS: Most of the 714 patients were born in Germany; 56 % were women and 44 % men, with a mean age of 52 years and a hepatitis duration of 18 years. More than 60 % of subjects younger than 65 years of age did not have a regular job, and 27 % were already retired. Only 47 % had a sufficient retirement insurance, whereas almost all had a health insurance. Only 12 % had an insurance covering work invalidity, and of those who had applied for the latter insurance, it was denied in 29 %. About 80 % of subjects reported that the hepatitis disturbed various aspects of their life. Only 4 % considered the public knowledge about hepatitis C as good or very good, but 80 % as bad or very bad. Of the subjects 40 % did not know how they had been infected; 37 % considered blood products as their infection mode, but only 10 % drug abuse. Almost all subjects knew that HCV cannot be transmitted via shaking hands, use of bathrooms, kisses or food (< 1 %, respectively). Surgery (17 %) and the dentist (15 %), however, were mentioned relatively often as a major risk for infection. About 80 % of subjects knew recent quantitative data on ALT and HCV-RNA, their genotype and the results of liver biopsy. Both mental and physical scores in the SF12 questionnaire were markedly reduced by about one standard deviation in subjects with HCV infection when compared with the general German population. Mental and physical scores deteriorated with increases in inflammatory and fibrosis scores. Subjects with negative HCV-RNA and normal ALT had the best quality of life, whereas subjects with high levels of HCV-RNA and ALT had the worst. CONCLUSIONS: The data show that the public opinion is wrong when pretending that hepatitis C today is just a disease of drug addicts. Our analysis demonstrates for the first time that many HCV-infected subjects in Germany have problems with their insurance and jobs. German subjects are well informed about their infection including genotype, liver histology, ALT and HCV-RNA; on the other hand, there are information deficits and fears concerning the mode of infection. The recent analysis clearly shows that HCV-infected subjects consider the public information about the HCV infection as catastrophically bad. The recent data in addition show that elimination of HCV decisively ameliorates quality of life, whereas mental and physical health get increasingly worse with progressive liver disease and unsuccessful antiviral therapies.