In 2009 an audit identified a sizeable gap between those diagnosed with hepatitis C and those seen at the specialist hepatitis C clinic. Subsequently it was decided that the Hepatitis B&C Managed Clinical Network Coordinator would follow up every confirmed hepatitis C polymerase chain reaction (PCR) positive case for which there was no referral received for specialist assessment.
Now all new referrals to the liver unit at the Royal Victoria Hospital for assessment of hepatitis C are entered into a referral/treatment database. The positive test result list is cross-referenced with the referral database and the hospital patient administration system to identify patients not referred within 4-6 months of the test and measures are taken when patients have not been referred. The team can now account for 100% of PCR-positive cases and virtually every patient who should be referred is being referred to treatment services.
In Northern Ireland Hepatitis C (HCV) is not a notifiable infection. A 2009 MCN audit looked at referral rates to the HCV clinic for new HCV polymerase chain reaction (PCR) positive cases. Thirty five per cent had failed to attend the HCV clinic; 10 per cent had been referred, but failed to attend (including one who was deceased), and 25 per cent were not referred. Thirty eight per cent of the HCV positive tests originated from GPs, the rest from specialist services.
Among GP-screened patients not referred, the most common reason was patient choice. The audit concluded that the non-referral rate for newly diagnosed HCV PCR positive patients is 25 per cent, compared with 30 per cent in 2007.
The objective was to close the gap between those testing positive and those being referred for specialist assessment at a hepatitis clinic. The project aimed to do so by providing information to clinicians at the time of diagnosis, with reminder letters and follow-up phone calls if the referral was still not made.
It was decided that the Hepatitis B&C Managed Clinical Network (MCN) would retrospectively follow up every four to six months on every laboratory-confirmed polymerase HCV PCR-positive cases for which there was no record of a referral being received for specialist assessment at the Royal Victoria Hospital liver clinic in Belfast.
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