Department of Gastroenterology, Townsville University Hospital, Townsville, Queensland, Australia.
Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2024 Jul;54(7):1155-1163. doi: 10.1111/imj.16364. Epub 2024 Mar 15.
Australia is struggling to meet its National Hepatitis B Strategy care targets, particularly in nonmetropolitan settings. It is vital to engage priority populations and improve their access to recommended care to reach these targets.
This retrospective study examined people living with chronic hepatitis B (CHB) in regional North Queensland, Australia, and determined whether their care adhered to current national CHB management guidelines. The analysis aimed to identify gaps in care that might be addressed to improve future outcomes.
All individuals referred to the gastroenterology clinic at the Townsville University Hospital in regional North Queensland, Australia, for CHB care between January 2015 and December 2020 were identified. Their linkage to care, engagement in care and receipt of guideline-recommended CHB care were determined.
Of 255 individuals, 245 (96%) were linked to care; 108 (42%) remained engaged in care and 86 (38%) were receiving guideline-recommended care in 2021. There were 91/255 (36%) who identified as Indigenous Australians. Indigenous status was the only independent predictor of not being linked to care (odds ratio (OR): 0.13 (95% confidence interval (CI): 0.03-0.60), P = 0.01), not being engaged in care (OR: 0.19 (95% CI: 0.10-0.36), P < 0.0001), not receiving guideline-recommended CHB care (OR: 0.16 (95% CI: 0.08-0.31), P < 0.0001) or not being engaged in a hepatocellular carcinoma surveillance programme (OR: 0.08 (95% CI: 0.02-0.27), P < 0.0001).
Current approaches are failing to deliver optimal CHB care to Indigenous Australians in regional North Queensland. Targeted strategies to ensure that Indigenous Australians in the region receive equitable care are urgently needed.
澳大利亚难以实现国家乙型肝炎战略的护理目标，尤其是在非城市地区。至关重要的是，要接触重点人群，改善他们获得推荐护理的机会，以实现这些目标。
本回顾性研究检查了澳大利亚北部地区的慢性乙型肝炎（CHB）患者，以确定他们的护理是否符合当前国家 CHB 管理指南。分析旨在确定可能需要解决的护理差距，以改善未来的结果。
确定了 2015 年 1 月至 2020 年 12 月期间，在澳大利亚北部地区汤斯维尔大学医院的胃肠病学诊所就诊的所有慢性乙型肝炎患者，以确定他们的护理联系、参与护理和接受指南推荐的乙型肝炎护理情况。
在 255 名患者中，245 名（96%）与护理联系；108 名（42%）继续参与护理，86 名（38%）在 2021 年接受指南推荐的护理。有 91/255（36%）人自认为是澳大利亚原住民。原住民身份是唯一与未与护理联系（比值比（OR）：0.13（95%置信区间（CI）：0.03-0.60），P=0.01）、未参与护理（OR：0.19（95%CI：0.10-0.36），P<0.0001）、未接受指南推荐的乙型肝炎护理（OR：0.16（95%CI：0.08-0.31），P<0.0001）或未参与肝细胞癌监测计划（OR：0.08（95%CI：0.02-0.27），P<0.0001）相关的独立预测因素。
目前的方法未能为澳大利亚北部地区的原住民提供最佳的乙型肝炎护理。急需制定有针对性的战略，确保该地区的原住民获得公平的护理。
