Pilot Programme: Nurse clinic for low risk chronic hepatitis B patients

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Authors (including presenting author) :
HW Wong (1), YY Lam (2), Michael KK Li (1), Lawrence SW Lai (2), KF Chan (1), Kitty Woo (2)
Affiliation :
(1) Medicine & Geriatrics, Tuen Mun Hospital, (2) Medicine & Geriatrics , Pok Oi Hospital
Introduction :
Chronic Hepatitis B virus (HBV) infection is a serious public health problem. It was estimated that 10.4% of male and 7.7% of female were HBV carriers in Hong Kong. Carriers of HBV are at increased risk of developing cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC). The number of Chronic Hepatitis B (CHB) patient on anti-viral treatment rose by 85% from ~2100 patients in 2011 to ~3900 patients in 2018. Due to the increasing case volume and patient’s knowledge deficiency in CHB, NTWC had commenced a “Nurse Hepatitis B assessment clinic” in TMH and POH to overcome this service gap and to deal with the increasing patient referrals.
Objectives :
1. To provide a structural protocol- driven management for selected low risk CHB patients. 2. To prove that the Nurse Hepatitis B clinic could provide a safe and effective nursing care for selected low risk CHB patients. 3. To empower our patients by providing knowledge on CHB management.
Methodology :
“Nurse Hepatitis B assessment clinic” has been implemented since October 2017. Patients who fulfilled the intake criteria (i.e. non-cirrhotic and low risk in development of HCC) would be referred to nurse clinic by GI specialist. Standard management such as liver biochemistry test, alpha fetoprotein test, HBVDNA test, liver ultrasound and FibroScan examination will be provided by trained specialty nurse. Patients who noted to have suspicious symptoms or abnormal findings will then be discussed in case conference and further investigation or earlier medical follow- up will be offered.
Result & Outcome :
1. 458 patients had attended the clinic from October, 2017 to December, 2018. 9 cases (2.2%) had default the follow up. Over 98 % of patients had achieved the target of symptom control in terms of liver biochemistry test, HBV DNA level, alpha fetoprotein level, and FibroScan without cirrhotic changes. 2. Abnormalities were identified in only 2 % of cases which included liver cirrhotic changes and newly developed liver lesions. Patients were then referred back to specialty clinic for further management. 3. Patient education is a key element in our clinic. The need of Hepatitis A vaccination, family screening of CHB, the importance of yearly ultrasound liver were explained and reinforced during nurse consultation session and thus to enhance their compliances on disease management. Over 95% of patients strongly agreed that our nurse clinic could enhance their knowledge and let them appreciate the importance of regular surveillance for hepatitis B. Over 96% of patients satisfied with our service and would like to follow- up at nurse clinic in the future. Conclusion: 1. “Nurse hepatitis B assessment clinic” enables selected low risk CHB patients with long follow-up duration could still enjoying standardize and quality management with low occurrence of complications. 2. The high attendance rate and positive feedback from patient showed that the nurse clinic was generally acceptable by patient and could help to retain patients in the surveillance programme in line with the recommendations from international guidelines. 3. Nurse hepatitis B assessment clinic could empower our patients by providing knowledge on CHB care to them.

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