Phillips Bethan, Corrigan Helen, Okpo Emmanuel
1 Medical Student, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
2 Health Protection Nurse Specialist, Public Health Directorate, NHS Grampian, UK.
Scott Med J. 2018 Aug;63(3):75-79. doi: 10.1177/0036933018776537. Epub 2018 May 27.
Introduction Contact tracing for chronic hepatitis B infection is an important activity for preventing the spread of hepatitis B infection. In the UK, the 'Green Book' recommends that all sexual and household contacts of individuals with chronic hepatitis B should be tested and vaccinated if required. This audit aimed to evaluate contact tracing in primary care. Barriers to effective follow-up of contacts of patients with chronic hepatitis B were explored and recommendations made. Methods and results Mixed method, including a survey of general practitioners and review of hepatitis B surveillance data from 1 June 2015 to 31 December 2015 held by NHS Grampian Health Protection Team. The audit was carried out in August 2016. Contact tracing was mainly by patient referral. Only 20% (4/20) of identified close contacts were tested. No contact eligible for vaccination was vaccinated, and 57% (8/14) of general practitioners who completed the audit questionnaire suggested that general practitioners do not have a role in contact tracing. Barriers identified were: lack of time, lack of resources and contacts being registered with a different practice. Conclusions This audit suggests that contact tracing for chronic hepatitis B in primary care is largely incomplete. Moving contact tracing from general practice to health protection teams in Boards may be a pragmatic way of improving follow-up activities.
引言
慢性乙型肝炎感染的接触者追踪是预防乙型肝炎感染传播的一项重要活动。在英国,《绿皮书》建议,慢性乙型肝炎患者的所有性接触者和家庭接触者都应接受检测,并在需要时接种疫苗。本次审核旨在评估初级医疗保健中的接触者追踪情况。探讨了慢性乙型肝炎患者接触者有效随访的障碍并提出了建议。
方法与结果
采用混合方法,包括对全科医生进行调查以及审查NHS格兰扁健康保护团队持有的2015年6月1日至2015年12月31日的乙型肝炎监测数据。审核于2016年8月进行。接触者追踪主要通过患者转诊进行。仅20%(4/20)的已识别密切接触者接受了检测。没有符合接种条件的接触者接种疫苗,并且完成审核问卷的全科医生中有57%(8/14)表示全科医生在接触者追踪中没有作用。确定的障碍包括:时间不足、资源匮乏以及接触者在不同诊所登记。
结论
本次审核表明,初级医疗保健中慢性乙型肝炎的接触者追踪在很大程度上不完整。将接触者追踪从全科医疗转移到各委员会的健康保护团队可能是改善随访活动的一种务实方法。