“B in IT” - a community-based model for the management of hepatitis B patients in primary care clinics using a novel web-based clinical tool

Abstract

BackgroundThe current model of care for the treatment of chronic hepatitis B (CHB) in Australia is through specialist Hepatology or Infectious Diseases clinics, and limited accredited primary care practices. Capacity is limited, and less than 5% of Australians living with CHB currently access therapy. Increasing treatment uptake is an urgent area of clinical need. Nucleos(t)ide analogue therapy is safe and effective treatment for CHB that is suitable for community prescribing. We have evaluated the success of a community-based model for the management of CHB in primary care clinics using a novel web-based clinical tool.MethodsUsing guidelines set out by the Gastroenterological Society of Australia, we developed an interactive online clinical management tool for the shared care of patients with CHB in primary care clinics, with remote oversight from tertiary hospital-based hepatologists and a project officer. We call this model of care the “B in IT” program. Suitable patients were referred from the specialist liver clinic back to primary care for ongoing management. Compliance with recommended appointments, pathology tests and ultrasounds of patients enrolled in “B in IT” was assessed and compared to that of the same patients prior to community discharge, as well as a matched control group of CHB outpatients continuing to attend a specialist clinic.ResultsThirty patients with CHB were enrolled in the “B in IT” program. Compliance with attending scheduled appointments within 1 month of the suggested date was 87% across all 115 visits scheduled. Compliance with completing recommended pathology within 1 month of the suggested date was 94% and compliance with completing recommended liver ultrasounds for cancer screening within 1 month of the suggested date was 89%. The compliance rates for visit attendance and ultrasound completion were significantly higher than the control patient group (p < 0.0001) and the “B in IT” patients prior to community discharge (p = 0.002 and p = 0.039, respectively).ConclusionsThe “B in IT” program’s novel web-based clinical tool supports primary care physicians to treat and monitor patients with CHB. This program promotes community-based care and increases system capacity for the clinical care of people living with CHB.

Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020

“…In east Africa, data on the seroprevalence of HBV are isolated and confined to only sub-group studies including, but not limited to, studies of blood donors [ 9 ], health care workers [ 10 ], pregnant women on antenatal care [ 11 , 12 ], as well as HIV-positive cohorts [ 13 ]. Studies that examine HBV prevalence at national and regional revels are scant in the literature.…”

A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South

“…At a policy level, our state does not have sobriety restrictions related to treatment access, though restrictions remain elsewhere in the country [ 41 ]. Among people who use drugs, HCV treatment can be a motivating factor to reduce substance use and/or to participate in harm reduction activities [ 42 , 43 ]. For one participant, substance use was his main source of connection to healthcare systems.…”

“…To reach these patients, it may be helpful to highlight improvements in patient-related outcomes with HCV cure [ 3 ]. The most significant impact of HCV cure may be an improved sense of psychological wellbeing related to relief about no longer living with the burden of an uncertain future or the fear of transmitting the infection to others [ 43 ]. Addressing the uncertainty of living with HCV and the potential to alleviate this uncertainty through treatment may be a strategy to address ambivalence.…”

Challenging collaboration of general practitioners and specialists for patients with complex chronic conditions: A scoping review to identify improvement strategies

“…Eight projects applied a before-and-after design with outcome measurements pre and post intervention (19, 23, 24, 30-34, 41, 45), whereof three before-and-after designs further compared the intervention group to a control group (38,47,48). Additionally, three projects compared the intervention group to a control group, which was usual care (28,(42)(43)(44).…”

“…Management was transferred to the GPs but overseen with an electronic treatment protocol by the hospital team. The primary care team was evaluated regarding their ability to treat and monitor patients with CKD (47). In a Swiss project, the GP was asked to follow a checklist closely and their adherence was monitored by the research team (26,27).…”