Authors (including presenting author) :
Lam YY (1), Fong MC (1), LAM CY (1), Lai SW (1), Yuen WH (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Pok Oi Hospital
Introduction :
The Hong Kong Viral Hepatitis Action Plan 2020 – 2024 has set out various priority actions for progressing towards the 2030 WHO targets of viral hepatitis elimination. It is a milestone towards significantly reducing the burden of chronic hepatitis B and hepatitis C. To eliminate HCV, the Hospital Authority Drug Formulary indication for the highly effective direct-acting antiviral (DAA) treatment has been expanded to cover all HCV patients, regardless of their disease severity and kicked off the macro-elimination of HCV program in 2022 1Q.
Objectives :
1) To provide international guideline standard of care to those HCV patients.
2) To streamline the Treatment Journey of Viral Hepatitis C.
3) To identify the patients' abnormities timely.
4) To reduced out-patient’s clinical attendance and relieve doctors’ workload
Methodology :
Patient list was provided by Hospital Authority Head Office (HAHO). Those patient with HCV positive would be actively contacted and recruited to our nurse clinic. A hepatitis C risk assessment profile would be setup for each patient who attended the Hepatitis Nurse Clinic. The profile includes 4 main components: 1) History of the client, 2) Assessment (blood test, FibroScan examination, recent ultrasound investigation, and 3) Hepatitis C education 4) Option of DAA treatment. Patient would have the blood check in the nurse clinic session. GI Physicians would decide and prescribe the appropriate DAA to patients effectively and efficiently during the doctor clinic after reviewing the profile and blood result. Nurse takes the role to monitor the drug compliance and the drug complication during the treatment.
Result & Outcome :
In order to adopt to the macro-elimination of HCV program, M&G/POH has tailor made in-house guideline for the GI team (included Physicians and nurses) to take care of those hepatitis C patients. With modern medications, SVR12 is now considered the cure marker. We also consider SVR 12 as the cure marker in our hospital. To be safe guard, we add SVR 52 as another cure marker to ensure nearly 100 percent remain virus-free for life and may be considered cured. From 2021 4Q to 2022 4Q, there were 200 attendances for Hepatitis C Nurse Clinic in POH. Total 129 number of patients were under the nurse clinic care. All patients achieved sustained virologic response (SVR) after 12 weeks completed HCV treatment. Implantation of in house guideline could streamline the treatment journey of viral hepatitis C, in order to reduce workload of medical staffs enabling them to focus on treatment of patients with more severe and complex problems. Meanwhile, nearly 100% patient and Physician satisfied with the Hepatitis Nurse Clinic. In house guideline combined with Hepatitis Nurse Clinic creates a win-win among hospital and patients.
