Authors (including presenting author) :
TUNG YMS (1), LEE SF (1), YIP LM (1), LEE HW(2), TUNG HYA(3), TUNG KYJ(3)
Affiliation :
(1) Department of Medicine and Geriatrics, Kwong Wah Hospital
(2) Information Technology Department, Kowloon Central Cluster
(3) Medicine, CUHK
Introduction :
The Government announced in last October the Hong Kong Viral Hepatitis Action Plan 2020 – 2024 to achieve the goal outlined by the World Health Organization (WHO) to eliminate the major public health threat posed by viral hepatitis by 2030. As MTCT is a significant route of HBV transmission, preventing MTCT is one of the highlight of the Action Plan. Apart from continuing with the existing arrangements on conducting universal screening for pregnant women and administration of neonatal vaccination for HBV, new initiatives on using antivirals for preventing MTCT of HBV will be introduced. Pregnant woman at 1st antenatal care visit of around 14 weeks gestation will be referred to Medical Hepatitis Clinic. These pregnant mothers will be offered anti-viral treatment from 3rd trimester till delivery. However, during the COVID-19 pandemic, these pregnant mothers have concerns of infection risk during clinic visit. This results in high default rates and will make this program having lower successful rate.
Objectives :
To invite pregnant woman at 3rd trimester to conduct Telemedicine through local initiatives Teleconsultation queueing system (TQMS). The consultation is made through Zoom and will consist of detailed counselling, education of treatment plan, importance of blood testing , post-natal follow up and drug safety during breast feeding.
Methodology :
Pregnant mother at 1st trimester will be seen by Obstetrician and have their HBV DNA checked. Those mothers with HBV DNA level higher than 200,000 IU/ml will be assessed by Hepatitis Nurses for their willingness to receive antiviral drugs. Those agree for Telemedicine will be given an appointment at 3rd trimester. Patients will be informed that physical examination is limited during teleconsultation and they have option for clinic visit in person. Those CHB mothers will then receive SMS message with a preset Zoom link and passcode, right before the consultation. Doctors or nurses will confirm the identities of the patients, explain about privacy and rules during telemedicine.
After consultation, GCRS blood request form, MOE prescription sheet as well as next follow up appointment sheet will be collected in non-clinic area to minimize risk of infection. Telephone survey was performed after the telemedicine to collect patients’ satisfaction, acceptance and comment.
Result & Outcome :
Antenatal mothers have a high acceptance rate of telemedicine. Most of these patients are young and has experience to use Zoom. Patients satifasction was higher than clinic visit because of the better environment to conduct the consultation, more time spent during the consultation and use of multimedia or screen sharing to explain some laboratory or radiology findings related to their hepatitis.
