Authors (including presenting author) :
Fung HT, Lai KPL, Wong SN, Luk MHM, Chan PF
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
Introduction :
To align with the recommendations from WHO’s global hepatitis strategy and Hong Kong Viral Hepatitis Action Plan in enhancing the chronic hepatitis B (CHB) management in primary care, pilot Family Medicine Hepatitis Clinics (FMHC) were set up in KEC since January 2023. For the assessment of CHB patients, transient elastography such as FibroScan is a crucial non-invasive assessment tool to assess the patients for the presence of significant fibrosis or cirrhosis and guide the decision for anti-viral treatment. Therefore, FibroScan service was implemented in KEC FMHC since May 2024 to enhance the clinical management of CHB patients in primary care. Liver steatosis assessed by controlled attenuation parameter (CAP) would also be performed. It was the first FibroScan service available in primary care of Hospital Authority.
Objectives :
1. To equip with the equipment and skills in performing liver stiffness and liver steatosis assessment of CHB patients in primary care
2. To reduce the need of referrals of CHB patients with elevated Fibrosis-4 (FIB-4) score or AST to Platelet Ratio Index (APRI) i.e. suspected liver fibrosis or cirrhosis to secondary care
3. To evaluate the outcomes of patients who received FibroScan service in FMHC.
Methodology :
Clinical guidelines on operation and interpretation of FibroScan were prepared. Training on operation of the FibroScan was received by family medicine specialists at Electrographic Diagnostic Unit of parent hospital. CHB patients with APRI and/or FIB-4 score above cut-off or CHB patients on anti-viral treatment without baseline FibroScan performed would be referred for assessment.
Relevant clinical information for all patients attending FMHC and received FibroScan service from 17th May 2024 to 29th November 2024 in Clinical Management System was reviewed.
Result & Outcome :
A total of 71 CHB patients were referred for FibroScan service from FMHC during the study period. The mean age of patients was 68 years old (range: 46-90), with 57.8% being female. 56.3% were on anti-viral treatment. 67.7% of patients had a FIB-4 score >1.45 and 15.5% had an APRI >0.5. 36.6% of patients were found to have elevated liver stiffness, with 26.7% showing borderline fibrosis (F2), 7% with probable advanced fibrosis (F3), and 3% with probable cirrhosis (F4). Additionally, 32.4% of patients were found to have severe fatty liver with a CAP ≥ 280 dB/m. 10% of patients was referred to the Medical Specialist Out-patient Clinic (SOPC) due to probable advanced fibrosis or cirrhosis.
Conclusion: With the pioneer FibroScan service provided by trained family medicine specialists in Hospital Authority, stable CHB patients could receive timely and comprehensive assessment and management in primary care. It also reduced unnecessary referrals to secondary care
