Yoshioka Naoki, Okumura Akihiko, Yamamoto Yukie, Yamaguchi Katsura, Kaga Atsuro, Yamada Kentaro, Hirosaki Takuya, Ishikawa Daisuke, Kunii Shin, Watanabe Kazumasa, Utsunomiya Setsuo, Hayashi Kazuhiko, Ishigami Masatoshi, Goto Hidemi, Hirooka Yoshiki
Department of Gastroenterology, The Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
Department of Medical Technology, The Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kainan Hospital, 396 Minamihonden, Maegasu-cho, Yatomi, Aichi, 498-8502, Japan.
BMC Infect Dis. 2017 May 8;17(1):330. doi: 10.1186/s12879-017-2438-1.
In Japan, approximately 0.9% and 1% of the whole population are infected with HBV and HCV, respectively. Doctors from departments other than gastroenterology often order viral hepatitis tests before an invasive examination or an operation. However, the notification of positive results to the patients and linkage to care is not appropriately performed. The in-hospital alert system was constructed to promote the notification and referral to gastroenterologists for patients with positive viral hepatitis tests, and its efficacy was evaluated.
The patients who tested HBsAg and anti-HCV antibody by chemiluminescent enzyme immunoassays and chemiluminescent immunoassays were investigated for whether they were notified of the positive results and if they were referred to gastroenterologists at our hospital. The notification and referral rate was compared before (from January to December 2014) and after the introduction of the alert system (from February to September 2016).
HBsAg-positive rate was 1.1% (69/6543) before the introduction of the alert system and 0.8% (41/5403) after it. The notification rate has significantly improved from 46% to 73% (p = 0.0061) and the referral rate has improved from 16% to 27%, while not significant. Positive rate of anti-HCV antibody was 2.1% (139/6481) before the introduction of the alert system and 2.4% (128/5322) after it. The rate of notification and referral has significantly improved from 35% to 62% (p < 0.0001) and from 6% to 23% (p < 0.0001), respectively.
The in-hospital alert system increased the rates of notification and referral of the patients with positive viral hepatitis tests. Enlightenment of doctors other than gastroenterologists on viral hepatitis and cooperation of medical staffs would be helpful to improve the notification and referral rates.
在日本，分别约有0.9%和1%的总人口感染乙肝病毒（HBV）和丙肝病毒（HCV）。胃肠病学以外科室的医生常在侵入性检查或手术前开具病毒性肝炎检测医嘱。然而，检测结果呈阳性时向患者的告知以及与治疗的衔接并未得到妥善执行。构建了院内警报系统以促进对病毒性肝炎检测结果呈阳性的患者进行告知并转诊至胃肠病科医生处，并对其效果进行了评估。
对采用化学发光酶免疫分析法和化学发光免疫分析法检测乙肝表面抗原（HBsAg）和丙肝抗体的患者，调查其是否被告知检测结果呈阳性以及是否被转诊至我院的胃肠病科医生处。比较了警报系统引入前（2014年1月至12月）和引入后（2016年2月至9月）的告知率和转诊率。
警报系统引入前HBsAg阳性率为1.1%（69/6543），引入后为0.8%（41/5403）。告知率从46%显著提高到73%（p = 0.0061），转诊率从16%提高到27%，但无统计学意义。警报系统引入前丙肝抗体阳性率为2.1%（139/6481），引入后为2.4%（128/5322）。告知率和转诊率分别从35%显著提高到62%（p < 0.0001）和从6%提高到23%（p < 0.0001）。
院内警报系统提高了病毒性肝炎检测结果呈阳性患者的告知率和转诊率。对胃肠病学以外科室医生进行病毒性肝炎知识培训以及医护人员之间的合作，将有助于提高告知率和转诊率。
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