Aims: Identify and review risk stratification and referral processes in the management of hepatitis B in general practice based on Chronic Hepatitis B (CHB) disease Registry data.
Background: In Australia hepatocellular cancer incidence is rising fastest of all internal cancers, largely due to rising rates of CHB infection in migrants born in countries where the disease is endemic. Regular monitoring and timely antiviral treatment initiation can reduce the risk of malignant transformation and is being trialled in the B Positive program.
Methods: We analysed initial screening data collected by the B Positive Registry from participating General Practices and ascertained if patient management and referral were consistent with Gastroenterological Society Australia (GESA) guidelines, which stratifies patients by risk level according to alanine aminotransferase (ALT) and viral load levels.
Results: Among the first 219 participants enrolled in B-Positive project 14% lacked documentation of ALT or viral load levels required to evaluate the stage of CHB disease. Approximately 67% had normal ALT and viral load levels and did not require referral but continued 6 monthly monitoring by primary health care provider. Fewer than 3% of patients had elevated ALT levels and viral loads. 1% of patients were not referred to the specialist as recommended by GESA. 18% of participants were referred to the specialist despite normal ALT and viral loads.
We anticipate that HCC risk factors such as family history and diabetes may be the reason for the 18% of patients referred who had normal ALT and viral loads.
Overall the present findings suggested that the general practitioners were following the recommended GESA criteria. The identification of knowledge gaps found in procedures and referral process will be vital to conduct further educational need in order to achieve successful and correct management of CHB and HCC risk.