What referral options are available for patients with hepatitis B?


Sponsored: Find out what GPs need to know when supporting patients to choose the right hepatitis B treatment pathway.

General practitioner talks to patient.
Accredited s100 community prescribers in primary care are often an overlooked referral option for hepatitis B treatment.

Tertiary specialists are often the key referral point for hepatitis B care and treatment. However, referral of patients to hospital-based tertiary specialists may not always be necessary nor is it the most appropriate option for chronic hepatitis B care.

Therefore, GPs must be aware of all options when supporting patients with hepatitis B in choosing treatment pathways.

Primary care – an underutilized option
Depending on the patient’s condition and clinical requirements, hepatitis B can often be managed and treated specifically in primary care by S100 community prescribers.

Approved s100 community prescribers are GPs, doctors, or a nurse practitioner who has completed additional training in hepatitis B surveillance and can prescribe highly specialized medications to treat hepatitis B.

However, primary care is often overlooked and underutilized in situations where it may be more beneficial for people with hepatitis B.

Latest survey results Viral Hepatitis Mapping Project: 2021 Hepatitis B National Report showed that nationally, only 8.3% of people receiving treatment for chronic hepatitis B had all prescriptions filled exclusively by their GPs.

Dr Jill Benson, a hepatitis B s100 community prescriber working in remote communities, says referring patients to s100 accredited GPs at the right time can help overcome the difficulties they may encounter in the three-tier system Treatment barriers.

She said many people with hepatitis B face challenges in accessing tertiary care, sometimes due to geography but also due to cultural and social barriers.

“These are primary care practitioners that we are familiar with. They trust us, we ensure continuity of care, and they generally have easier access to us.”

According to the survey results Viral Hepatitis Mapping Project Australia is falling behind national treatment targets for chronic hepatitis B, so barriers to accessing care must be reduced or eliminated.

When is specialist referral most appropriate?
Referral to a specialist for the management and treatment of hepatitis B may be appropriate in many circumstances, including (but not limited to) patients with:

  • pregnant
  • Co-infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV) or hepatitis D virus (HDV)
  • you have cirrhosis
  • Previous antiviral treatment for hepatitis B
  • There are complex comorbidities, lack of participation, failure to follow up, or other issues.

Urgent specialist care is almost always needed when:

  • Suspected or confirmed liver cancer (HCC)
  • decompensated cirrhosis
  • Severe acute exacerbation of hepatitis B
  • Prescription of immunosuppressive drugs (including chemotherapy).

How do you know whether to refer a patient to an s100 community prescriber?

ASHM, Australia’s peak professional body representing healthcare professionals in HIV, BBV and sexual and reproductive health, has developed a new resource for clinicians to help identify the best referral pathways for patients.

The Hepatitis B Referral Options Tool is an interactive resource that guides clinicians through a series of short questions to help determine whether S100 Community Prescriber is appropriate for a patient.

It is important that all treatment options are discussed with the patient and take into account their personal preferences and circumstances.

If primary care referral is determined to be appropriate for the patient, clinicians can use the Hepatitis B S100 Community Prescribers interactive online map and clinical communication tool to find and communicate with appropriate prescribers.

More resources

Understanding the referral pathways available is one of the best ways clinicians can support people living with hepatitis B.

The following tools and information are part of ASHM’s resources to support primary care clinicians in diagnosis and referral. A full set of resources can be found on ASHM’s Referral and Clinical Support Resources webpage.

This article is sponsored and written by ASHM and is for general information purposes only.

When deciding on referral options for patients with chronic hepatitis B, physicians and clinicians should consider each patient’s individual circumstances and clinical requirements as well as their own medical knowledge.

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ASHM Australian HIV Hepatitis B Society s100 Viral Hepatitis and Sexual Health Medicine

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