Authors: (including presenting author): :
Lai KPL (1), Chan PF (1), Fung HT (1), Wong SN (1), Luk MHM (1), Kung KN (2) Tsang WC (3)
Affiliation: :
(1) Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC) (2) Department of Medicine & Geriatrics, United Christian Hospital (3) Department of Medicine, Tseung Kwan O Hospital
Introduction: :
Chronic hepatitis B (CHB) is prevalent in Hong Kong with 6.2% of population aged 15-84 tested positive for HBsAg according to the Population Health Survey conducted in 2020-22. To align with the recommendations from WHO and the Hong Kong Government in enhancing CHB management in primary care, a pilot collaboration model between Family Medicine and Medicine on CHB management was implemented in KEC in January 2023. Family Medicine Specialist Clinics (FMSC) were set up to receive referrals from General Out-patient Clinics (GOPC) for CHB patients with deranged liver function or family history of hepatocellular carcinoma (HCC) and from Hepatology Clinic for stable CHB patients on long-term antiviral.
Objectives: :
(1) To provide comprehensive clinical assessment, treatment and monitoring for CHB patients in FMSC (2) To facilitate downloading of CHB patients from Hepatology Clinic
Methodology: :
Collaborative works included formulation of clinical guidelines, setting up of mutually agreed bi-directional referral criteria, establishment of knowledge exchange platforms between hepatologists and family medicine specialists and arrangement of special laboratory tests for hepatitis B. To evaluate the outcomes of patients managed in the FMSC, clinical information of all patients attending the clinics from January 2023 to December 2023 were reviewed.
Result & Outcome: :
353 patients were referred from GOPC. Mean age of patients was 59.9 years old (range 31-94). 65.7% were female. 78% and 23% of patients were referred for deranged liver function and family history of HCC respectively. 40.2% (106/264) of patients who had more than one follow-up were started on antiviral with a mean treatment period of 5 months. The median ALT level was significantly dropped from 51.0 U/L (Q1-Q3: 39.0-72.0) to 26.0 U/L (Q1-Q3: 18.0-37.0) after antiviral treatment. (p<0.001) The median AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) index scores were significantly improved from 0.41 (Q1-Q3: 0.32-0.62) to 0.28 (Q1-Q3: 0.22-0.37) and from 1.64 (Q1-Q3: 1.24-1.98) to 1.40 (Q1-Q3: 1.06-1.74) respectively. (p<0.001) Among the patients with rechecked HBV DNA level after initiation of antiviral, 87.3% (48/55) had their levels dropped to less than 2 log IU/ml after a mean treatment period of 6 months. 31.2% of all patients had private FibroScan performed. 3.9% and 11.7% of 77 patients with FibroScan reports available were found to have probable advanced fibrosis and cirrhosis respectively. 14 patients (4.0%) were referred to secondary care for abnormal FibroScan results, elevated AFP and concomitant liver diseases including alcoholic liver disease and autoimmune hepatitis. From June 2023 to December 2023, 198 CHB patients on antiviral were downloaded from Hepatology Clinic and seen in the FMSC. Conclusion: In collaboration with hepatologists, family medicine specialists could provide appropriate assessment and management to patients with CHB in primary care.
