Authors (including presenting author) :
Wong SN, Luk MH, Chan PF
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster
Introduction :
Chronic Hepatitis B (CHB) infection causes a significant public health concern with a prevalence of 6.2% among those aged 15 to 84 in Hong Kong. To align with the Government commitment in enhancing care for CHB patients and to stratify patients at the right level of care, pilot CHB Family Medicine Specialist Clinics (FMSCs) were set up in KEC in 2023 to receive referrals from General Out-patient clinics for CHB patients with deranged liver functions or family history of hepatocellular carcinoma.
Objectives :
To review the demographic characteristics and clinical outcomes of patients referred to the pilot CHB FMSC.
Methodology :
A retrospective, cross sectional study was conducted. All patients attended the pilot CHB FMSCs between 1st February 2023 and 30th September 2023 were recruited. Relevant clinical data were retrieved from Clinical Management System for analysis
Result & Outcome :
Results:
255 patients were recruited during the study period with a median age of 62 years old, and 63.1% were female. 106 (40.9%) patients were found to be CHB carriers during routine check-up in private while 71 (27.4%) were diagnosed in Hospital Authority (HA) clinics during work-up for deranged liver functions. 29 (11.2%) and 44 (17.0%) patients were diagnosed during blood donation and antenatal check-up respectively. Majority of them (79.2%) had regular follow-up in HA clinics, while 17.4% of them had no regular follow-up despite known to be hepatitis B carriers.
The median HBV DNA level was 1.75x10^3 IU/mL (IDR: 44.2 - 7.09x10^5). 111 patients (43.5%) were started on anti-viral treatment. The median ALT level decreased significantly from 49 U/L to 25 U/L after treatment (p < 0.001). The median HBV DNA level also decreased significantly from 1.76 x10^5 IU/mL to 10.0 IU/ml after treatment (p < 0.001). FibroScan was performed on 87 (34.1%) patients for assessment of liver stiffness, from which 28.5% of them had significant liver fibrosis (F2 or above) which warranted regular monitoring; and 13 out of 87 (14.9%) patients were referred to hepatologists for further evaluation and management.
Conclusion:
The pilot CHB FMSCs demonstrated successful outcomes in providing timely and comprehensive management to CHB patients. A significant proportion of patients were indicated for anti-viral treatment, and nearly one-third of patients were found to have significant liver fibrosis. Expansion of similar clinics in primary care was warranted, as proper management of CHB patients does not only decrease the risk of complications but also reduce the long-term burden on the health care system.
