No such thing as a model of care: Lessons from an Integrated Hepatitis B Service

The 9th Australasian Viral Hepatitis Conference has offered up a variety of lessons learnt from trials and piloted services. The question is, which model/s will be taken on if we are to massively scale up our response to hepatitis B (HBV)?

During the proffered papers session on Clinical Care for HBV, Thursday, 18 September, Tracey Cabrie addressed the topic of improving quality of care for people living with HBV in primary care, with some preliminary data from the Integrated Hepatitis B Service, run out of the Royal Melbourne Hospital. Tracey works as a Hepatitis B Integrated Care Nurse in the Service, a role which is shared, and funded for 0.8 FTE.

The Integrated Hepatitis B Service provides support to high case load GP clinics, through capacity building, developing clinical pathways, and supporting the increase in testing and vaccination. Through the Hepatitis B Integrated Care Nurse, the service has engaged 45 primary care professionals within 5 primary care clinics in 2 years. Within these clinics, 830 patient records have been audited, with 328 patients identified as having chronic hepatitis B (CHB).

Cabrie’s team collected baseline and follow up data at 18 months at 2 clinics. Of patients with CHB, the majority were in the immune control phase. At follow up, the majority were managed by their GP, compared to the majority at baseline being managed by a specialist. There were improvements in rates of annual LFTs and DNA in both clinics at follow up. Between 20-30% improvements in liver ultrasounds for HCC (in line with the guideline) at follow up.

Lessons learnt?

Relationship building with the clinicians was essential to capacity building

Patient-centred care is vital, and therefore service delivery should be varied, as each practice is different, and each patient's needs are different

The audit of patient records supported the idea of developing systems, and the need to provide or link in training and resources

Guideline-based CHB management is achievable in a primary care setting

In short, it seems there’s “no such thing as a model of care” – real quality care needs to be flexible, responsive and appropriately resourced. CHB management is complex and therefore requires a nuanced and multi-faceted intervention.