What referral options exist for people with hepatitis B?


29/11/2023 4:09:42 PM

SPONSORED: Discover what GPs need to know when supporting patients to choose the right hepatitis B treatment pathway for them.

GP speaking with a patient.
Accredited s100 community prescribers in primary care settings are often an overlooked referral option for hepatitis B treatment.

Tertiary specialists are often a key referral point for hepatitis B care and treatment. However, referring patients to a tertiary specialist in a hospital setting may not always be necessary or the most appropriate option for chronic hepatitis B care.
For this reason, it is essential GPs know all the options when supporting patients diagnosed with hepatitis B to choose their care pathway. 
Primary care – an underutilised option
Depending on the patient’s circumstances and clinical requirements, hepatitis B can often be managed and treated exclusively in primary care settings by s100 community prescribers.
Accredited s100 community prescribers are GPs, medical practitioners, or nurse practitioners who have completed additional training to monitor hepatitis B and can prescribe Highly Specialised Drugs for the treatment of hepatitis B.
However, primary care is often overlooked and underutilised in situations where it may be more beneficial to people living with hepatitis B.
Findings from the latest Viral Hepatitis Mapping Project: Hepatitis B National Report 2021 show that nationally, only 8.3% of people receiving treatment for chronic Hepatitis B had all prescriptions provided exclusively through a GP.
Dr Jill Benson, a hepatitis B s100 community prescribing doctor working in remote communities, says referring patients to s100 accredited GPs when appropriate can help overcome barriers to treatment they may otherwise encounter in the tertiary system.
‘Many people with hepatitis B have challenges accessing tertiary care, sometimes due to geography, but also due to cultural and social barriers,’ she said.
‘These are people we know well as primary care practitioners. They trust us, we ensure continuity of care, and we are usually easier for them to access.’
With findings from the Viral Hepatitis Mapping Project revealing Australia is lagging behind national treatment uptake targets for chronic hepatitis B, it is imperative that barriers to accessing care are reduced or removed.
When are specialist referrals most appropriate?
There are many circumstances where referral to a specialist for the management and treatment of hepatitis B may be appropriate, including (but not limited to) when a patient:

  • is pregnant
  • has co-infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV), or hepatitis D virus (HDV)
  • has cirrhosis
  • has received hepatitis B antivirals before
  • has complex comorbidities, lack of engagement, loss to follow up, or other concerns.
Urgent specialist care is almost always required when there is:
  • 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?
New resources for clinicians developed by ASHM, Australia’s peak professional body representing healthcare professionals working in HIV, BBV and sexual and reproductive health, can be used to assist in determining the best referral pathway for patients.
The Hepatitis B Referral Options tool is an interactive resource which guides clinicians through a short series of questions to help decide whether an s100 community prescriber is appropriate for a patient.
It is important that all treatment options are discussed with patients and their individual preferences and circumstances are taken into account.
If it is determined that a primary care referral is appropriate for a patient, the Hepatitis B s100 Community Prescribers interactive online map and Clinical Communication Tools can be used by clinicians to find and communicate with a suitable prescriber.
Further resources
Understanding the available referral pathways is one of the best ways clinicians can support patients with hepatitis B.
The following tools and information are part of ASHM’s resources to support primary care clinicians at the time of diagnosis and referral. The full suite of resources can be found on ASHM’s Referral and Clinical Support Resource webpage.
  This article was sponsored and written by ASHM and is for general information purposes only.
Medical practitioners and clinicians should take into consideration the individual circumstances and clinical requirements of each patient, and their own medical knowledge, when deciding on referral options for people living with chronic hepatitis B.
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ASHM Australasian Society for HIV Hepatitis B s100 Viral Hepatitis and Sexual Health Medicine

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Dr Roderick Graham Bain   21/02/2024 12:33:04 PM

Good patient-GP communication is foremost in the relationship. It will provide the best basis for clinical diagnosis and treatment.