Practice guidelines have been developed to select patients with chronic hepatitis B who might benefit from antiviral treatment.^1–3 These sophisticated guidelines are directed at specialist care, and include the assessment of serum hepatitis B virus (HBV) DNA. However, most patients with chronic HBV are diagnosed in primary care where HBV DNA is usually not assessed. A simpler, less expensive guideline that can be used at the primary care level to select patients for referral to specialist care can reduce the number of patients referred who, after evaluation by a specialist, are ineligible for treatment. By preventing the referral of ineligible patients, the disappointment that patients with high expectations experience after referral to a specialist is avoided. Furthermore, it reduces the burden on the healthcare system.

A guideline for the referral of patients with chronic HBV …