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Viral hepatitis
P73 Referral of hepatitis B surface Ag positive patients to specialist hepatology care: need for improvement
  1. B Smith,
  2. I Brown,
  3. D Muir,
  4. P Nutter
  1. Imperial College, Healthcare NHS Trust, London, UK

Abstract

Introduction There are a number of obstacles to ensuring appropriate diagnosis and treatment of both hepatitis B and hepatitis C patients. A major potential problem is the failure of onward referral to specialist care following the finding that a patient is HBsAg (+). This is of particular concern due to existing misconceptions relating to supposed “healthy carrier states” and lack of knowledge regarding efficacy of current hepatitis B treatments.

Aim The aim of this study was to establish what proportion of patients found to be HBsAg (+) by both primary care and hospital clinicians were referred to, and attended specialist hepatology clinics.

Method All HBsAg (+) results obtained by the virology department at St Mary's Hospital over a 3 year period from Jan 1 2007 to Dec 31 2009 were identified. Duplicate tests, equivocal serology and unidentifiable patients were removed. The source of the request was recorded: primary care, hospital out-patient, in-patient, Accident and Emergency or ante-natal clinic. The patient administration system at SMH was used to determine how many of these patients attended at least one hepatology clinic at SMH. For patients who failed to attend hepatology clinics the hospital notes were reviewed (when available) to try to establish reasons for lack of onward referral.

Results Initially 2698 HBsAg (+) results were found. This was reduced to 1094 patients by excluding duplicate requests (including from within hepatology), indeterminate (n=18) and untraceable confidential hospital numbers used by the sexual health clinic (n=459).

The Abstract P73 Table 1 indicates patients tested in primary care were far less likely to reach specialist care, Antenatal patients were the commonest group tested in the hospital setting who failed to reach hepatology clinics (22 patients in total) but they also made up the largest group of patients tested in secondary care. It was not possible to exclude the possibility that some patients may have been attending hepatology clinics outside SMH, but this was not documented in notes as an explanation for lack of referral.

Abstract P73 Table 1

Results

Conclusion This retrospective review is imperfect and may underestimate the number of hepatitis B carriers reaching specialist care. Nonetheless a major problem clearly is still occurring despite very directive information appearing on virology result slips; the vast majority of patients found to be hepatitis B carriers in the community are not referred for appropriate follow-up. In-hospital referral rates are significantly better. This is consistent with a concerning survey of London GPs regarding knowledge of hepatitis and indications for referral (Taylor et al Gut 2009;59(Suppl1):PTU-072) and indicates the need for improving education in this area.

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