When patients go home from the hospital after an episode of overt hepatic encephalopathy (OHE), they may first see their primary care provider before follow-up with their specialist. In an interview with MD Magazine, Arun B. Jesudian, MD, and Kimberly A. Brown, MD, discuss tips and suggestions for primary care physicians in managing patients with OHE who have cirrhosis.
There has been a noted disconnect between inpatient and outpatient care for patients with cirrhosis. Many of the patients who are started on medications have never seen their specialist before and may never see them again. They are often discharged directly to their primary care physicians for follow-up care. Brown notes that the lack of responsibility is a common reason why primary care physicians avoid writing prescriptions for rifaximin, a medication used to treat OHE. She argues that primary care physicians should not avoid keeping a patient on medication purely in hopes that the specialist would take responsibility.
One of the benefits of rifaximin is its safety record. Although the primary physician prescribing the medication may not have as much experience with rifaximin as the specialist who initiated it, the medication is very safe and has a long safety record. It is an antibiotic, but it neither causes antibiotic resistance nor any serious side effects. Discontinuing rifaximin for any reason is very rare and no more frequent than with the placebo in studies. Therefore, primary care physicians should feel comfortable prescribing rifaximin and other essential medications.
There is a push to develop a cirrhosis toolbox that can be given to primary care physicians along with the patient. This toolbox would explain the purpose of the medications, why the patient is on them, and how important it is to stay on them. Jesudian and Brown note that it is an uphill battle to get the message out, but it is worth fighting so that every provider would feel comfortable prescribing these essential medications that could be the difference between a patient with decompensated cirrhosis not being readmitted shortly after their HE admission or being back in the hospital within a week or two.
In conclusion, primary care physicians should not be afraid to continue the medications prescribed by the specialist, including rifaximin. It is a safe medication and should be continued as prescribed. Primary care physicians should communicate with the specialist if they have any questions about the medication or if their patient’s condition is not improving. It is an uphill battle to get the message out, but it is worth fighting to ensure that every patient receives the best care possible.
