A shared care program for the management of patients with chronic hepatitis B in a Canadian primary care refugee clinic

Objectives

Refugees in Canada are disproportionately affected by chronic hepatitis B (CHB) and its complications due to healthcare barriers and resettlement challenges. In 2011 the Mosaic Refugee Health Clinic (MRHC) in Calgary, Canada began a shared care model for CHB. Family physicians identify and monitor chronically infected patients, reviewing cases with hepatology.

Study design

A cohort of all adult patients (≥18 years old) with a positive hepatitis B surface antigen result (HBsAg) between January 1, 2011 and December 31, 2020 was assessed through retrospective chart review.

Methods

Variables collected included basic demographics and disease characterization, monitoring parameters, and follow-up intervals. These were analyzed using descriptive statistics.

Results

A total of 171 cases were managed during the study time frame, representing 2.6 % of the total number of adult patients (6511) taken into the clinic. Of the cohort, 139 patients (81.0 %) were followed for more than a year. Nearly all patients (98 %) completed a full panel of recommended baseline lab testing, 88 % met ongoing ALT lab surveillance targets, and 70 % ultrasound surveillance. The majority (83 %) were reviewed by the hepatologist within 6 months.

Conclusions

This unique model is the first example of a registry of CHB patients in a longitudinal program at a refugee primary care clinic. The observed high rates of adherence were likely achieved by empowering a primary health care interdisciplinary team with specialty support. No funding was utilized for this study.