Authors (including presenting author) :
Fong TS(1), Chan WYM(1), Mak CK(1), Mak LKK(1), Tsang WC(2), Chow CW(2)
Affiliation :
(1)Department of Pharmacy, (2)Department of Medicine, Tseung Kwan O Hospital
Introduction :
In Hong Kong, it is estimated that 7.2% of population, ~540,000 patients, are infected with chronic hepatitis B (CHB). Without proper care and monitoring, CHB patients are at risk of developing complications, including cirrhosis and hepatocellular carcinoma (HCC). Hong Kong Viral Hepatitis Action Plan 2020–2024, formulated in 2020, established the importance of enhancing service capacity for CHB patients. On 5th March 2021, Tseung Kwan O Hospital piloted Hepatitis Pharmacist Clinic as a shared-care model with hepatologists and nurses, aiming to optimize care for CHB patients.
Objectives :
1) To improve patient care in management of CHB through an interdisciplinary care approach. 2) To relieve hepatologists in monitoring CHB patients at risk of drug-related issues.
Methodology :
Hepatologists would refer patients with stable clinical conditions who were 1) newly started on antivirals or 2) at increased risk of drug-related issues, e.g. drug compliance issues, renal impairment or polypharmacy, to Hepatitis Pharmacist Clinic. Following an established protocol, patients were cared under a shared-care model, with alternate hepatologist and pharmacist consultations. Pharmacists would assess patients’ disease control from relevant laboratory results, review medication profile, evaluate renal function, monitor compliance and possible adverse drug reactions. Pharmacists would also advise on lifestyle precautions, arrange laboratory tests and ultrasound for HCC surveillance when appropriate. If patients’ conditions required medical attention, pharmacists would seek advice from hepatologists.
Result & Outcome :
As at 31st December 2022, 169 CHB patients were referred to Hepatitis Pharmacist Clinic and 299 consultations were conducted. A total of 177 drug-related problems (DRPs) were identified and resolved by pharmacists. Most DRPs were related to compliance problems (60, 33.9%), deranged liver/renal function tests requiring additional monitoring or dosage adjustment (55, 31.1%) and allergy/adverse drug reactions (16, 9.0%). Under the shared-care model, 89.0% consultations were managed by pharmacists according to protocol without referring to hepatologists. This showed that pharmacists were able to manage stable CHB patients and identify patients who required medical attention. Hepatitis Pharmacist Clinic, integrating in a shared-care model, was able to enhance service quality to CHB patients by close monitoring of disease control, early detection and management of drug-related issues. With pharmacists’ input between hepatologist consultations, hepatologists could extend follow-up duration for CHB patients, thus, increasing service capacity in the long run.
