Authors (including presenting author) :
Ng TC, Chiu H, Ko KL, Liu Kevin, Yuen MF, Seto WK
Affiliation :
Department of Medicine, Queen Mary Hospital
Introduction :
Chronic hepatitis B virus (HBV) infection is present in 7.8% of the Hong Kong population, and have increased risk of developing cirrhosis and liver cancer. Currently 10,689 chronic HBV patients are followed up at the Liver Clinic of QMH. To enhance service need, The Integrated Model of Specialist Outpatient Service through Nurse Clinic (Hepatitis) in QMH was commenced in April 2020, focusing on enhancing clinical effectiveness and safety of nurse-led care.
Objectives :
To provide nursing interventions through a Hepatitis specialist nurse clinic with emphasis on clinical effectiveness, risk management and safety.
Methodology :
The clinic was developed with the support from cluster representatives and HAHO executives, who established an approved protocol and issued in 6 September, 2019. An Advanced Practice Nurse who has completed relevant specialty training is responsible for the nurse clinic. Gastroenterology specialists screened for eligible patients and obtained patients’ consents for referral. Nursing interventions included clinical assessment, follow-up reminders, transient elastography (Fibroscan) measurements, compliance monitoring and educational programmes.
Result & Outcome :
From April to December 2020, 1,071 patients (54.2% male) were recruited, with a mean age of 52.3 (±4.1) years, taking up 10.0% of the total chronic HBV clinic patient population. Four hundred and sixty-five patients (43.4%) were on antiviral treatment. Three hundred and ninety-four patients (36.8%) have attended the first follow-up visit at the Hepatitis Nurse Clinic, with 317 (80.5%), 217 (55.1%) and 70 (17.8%) having undergone blood tests, liver ultrasonography and Fibroscan respectively. 604 laboratory and radiology results were screened by the clinic nurse, 10 (1.7%) requiring further medical advice via fast track consultations, while the remaining 594 (98.3%) were managed successfully by the specialty nurse by following department pre-approved guidelines. All 394 attended patients (100%) benefited on educational intervention, which included information such as general information on HBV, HBV treatment, the importance of drug compliance, surveillance liver ultrasonography and lifestyle modification. 319 patients undergone pre-and-post knowledge tests, with 272 (85.2%) achieving knowledge advancement. Among 246 patients undergoing satisfactory survey, all (100%) had positive feedbacks.
Conclusion
The Integrated Model of Specialist Outpatient Service through Nurse Clinic (Hepatitis) is effective in providing nurse-led care while ensuring patient safety, and integral in enhancing service demand among the large population of chronic HBV patients.
