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Clinical hepatology
P18 The impact of Health Protection Agency guidelines on the management of hepatitis B in West Kent
  1. I Coltart,
  2. J Petersen-Camp,
  3. M Holland,
  4. G Bird
  1. Department of Gastroenterology, Madistone and Tunbridge Wells NHS Trust, UK

Abstract

Introduction In 2006, the Health Protection Agency (HPA) issued standards regarding the follow-up of Hepatitis B infection. West Kent has a catchment population of 655 000 and a local viral hepatitis service.

Aim We wished to assess the management of Hepatitis B infection within West Kent following the introduction of these guidelines and audit local compliance.

Method We identified all patients who tested positive for Hepatitis B surface Antigen (HBsAg) over a 2-year period (January 2006 until December 2007) from microbiology records. We examined the referral source, and whether basic demographic, biochemical, and virological parameters had been recorded. In addition, we examined whether the patient was referred to the viral hepatitis service. The referral source was grouped into six categories: Primary Care, Obstetrics, Genito-Urinary Medicine, Occupational Health, General Medicine and “Other”.

Results 21 366 screening tests for Hepatitis B were performed during the 2-year period. Obstetrics accounted for 8299/21 366 (38.8%) of requests, followed by Genito-Urinary Medicine 6998/21 366 (32.8%), Primary Care 4284/21 366 (20.1%), and “Other” with 1128/21 366 (5.2%). Occupational Health (329/21 366) and General medicine (328/21 366) accounted for 1.5% of all screening requests. 89/21 366 (0.4%) of tests were positive for HBsAg. The median age of patients testing positive for HBsAg was 34 years. Ethnicity data were missing in 60% (53/89) of positive results. 59% (52/89) of positive results had been requested in Primary Care, followed by 21% (19/89) in General Medicine, and 11% (10/89) in Genito-Urinary Medicine. 57% (41/89) of patients testing positive for HBsAg had liver function tests checked within 6 months. 44% (39/89) of patients were referred on to specialist hepatology services. 28% (25/89) had radiological imaging following the positive HBsAg result. 6% (5/89) patients met the diagnosis criteria for acute hepatitis B but only two of these patients were referred on to specialist services.

Conclusion During the 2-year study period, 3.3% of the population in West Kent was tested for Hepatitis B infection. The majority of positive cases were in samples referred from primary care. However, less than half the patients with a positive HBsAg result were referred to specialist services. This contravenes HPA guidelines and leaves patients at risk of developing the sequelae of untreated Hepatitis B infection. Our experience shows that the HPA standards are yet to fully penetrate into routine clinical practice. With thanks to the Department of Microbiology, Maidstone Hospital.

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