Authors (including presenting author) :
Wong HW, Li KK, Chan KF
Affiliation :
Tuen Mun 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 carrier in Hong Kong. Carriers of HBV are at increased risk of developing cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC). Since the relaxation of HA treatment criteria, 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. The heavy caseloads had created a tremendous pressure to the specialty clinic as reflected by prolonged clinic finishing time and prolonged interval of clinic appointment. TMH had commenced a “Nurse Hepatitis B assessment clinic” to overcome the increasing service demand.
Objectives :
1.To provide structural protocol- driven assessment for uncomplicated CHB patients. 2.To streamline the management by assisting hepatologist in managing the uncomplicated CHB patients requiring antiviral treatment. 3.To reduce consultation time, lengthen follow- up period and standardise the care of CHB patients.
Methodology :
“Nurse Hepatitis B assessment clinic” has been implemented since October 2017. Patients who fulfilled the intake criteria would be referred to nurse clinic by GI specialist. A comprehensive history taking, health assessment, health education, FibroScan and ‘hepatitis B assessment profile’ will be provided for individual patient. The importance of yearly surveillance ultrasound liver will be explained and reinforced during nurse consultation session. Patients 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 :
Result: 1.410 patients had attended the nurse clinic in last year. Only 9 cases (2.2%) had default their appointment and refused to follow up in the nurse clinic. 2.Over 98 % of patients had achieved the target of symptom control in terms of normal liver biochemistry, HBV DNA and alpha fetoprotein test. Only 1.9% patients were noted to have abnormal blood result such as elevated in ALT and HBV DNA viral load. Follow-up investigations and early medical follow- up were offered to those patients. 3.79.4 % of patients who follow-up in nurse clinic had done yearly ultrasound liver for HCC surveillance, as compared to 61.3% of patients not follow- up in nurse clinic (p= 0.004). This result reflected that the nurse clinic could help our patients to adhere with the surveillance plan as suggested. 4.Suspicious lesions were identified in 2 patients by liver ultrasound. Follow up ultrasound liver and urgent CT scan was then offered immediately. One patient was diagnosed with HCC and was urgently referred to surgical unit for further management. 1 % of patients were discharged from nurse clinic due to progressive development of liver cirrhosis, complication and loss of hepatitis B surface antigen. 5.Over 95% of patients strongly agreed that our nurse clinic could enhance their knowledge and let them appreciate the importance of regular surveillances. Over 96% of patients satisfied with our service and would like to follow- up at nurse clinic in the future. 6.All patients could be follow- up by health care providers regularly in every 24 weeks, as compared to over 30 weeks in Hepatology clinic alone. Conclusion: 1.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. 2.The standardisation of care enables a timely identification of patients with hepatic decompensation or HCC which reflected that it is an effective and safe way to manage the uncomplicated CHB patients requiring antiviral therapy. 3.Patient could be assessed by health care providers regularly for every 24 weeks and the workload of HCC surveillances could also be shared by the nurse clinic.
Co-location with:
