Background

Hepatocellular cancer (HCC) is among the top 10 causes of cancer death in Australia, with ~80% of cases attributable to chronic viral hepatitis. Although 60-80% of HCCs are preventable by antiviral therapies, multiple barriers exist in the diagnostic and treatment continuum. Chronic hepatitis B (CHB) is the main cause for rising HCC rates in Western Sydney, where the greatest burden of disease is among people born in hepatitis B endemic countries. 

Method

A shared care model of CHB management was developed to support local general practitioners to deliver optimal care for their CHB patients. The model ensures GPs are supported by a clinical nurse specialist in triaging patients with CHB and referral to local liver specialists (as necessitated) according to current management guidelines.

Results

Since program inception in March 2015, 120 patients have been enrolled across two general practices at Blacktown and Auburn in the Western Sydney local government area. All patients have been triaged into an appropriate pathway of ongoing monitoring and care, including a recommended surveillance interval for early detection of HCC.  Ten patients commenced antiviral treatment and were effectively transitioned back to their general practitioner.

Conclusion

Piloting a shared care model of CHB management led to timely referral, monitoring and surveillance of patients, thereby assisting in the prevention of HCC in the populations at risk. Implementing a system to allow for the tracking of patient results and HCC surveillance requirements means patients are engaged in a program that ensures cancer screening is correctly implemented. This model also empowers GP’s in the process of caring for their patients with CHB in an environment in which the patients feel comfortable.