Quality statement 2: Referral for specialist care

Quality statement

People who test positive for hepatitis B surface antigen (HBsAg) are referred to specialist care for further assessment.

Rationale

Chronic hepatitis B infection affects the liver and can cause serious health problems if left untreated. It is important that people who test positive for HBsAg are referred for specialist care so that they can be assessed for the stage of hepatitis B and for other infections (such as HIV, hepatitis C and hepatitis D). Further assessment in specialist care is essential in determining whether and when to start pharmacological treatment. This statement does not apply to pregnant women who test HBsAg-positive at antenatal screening, which is the focus of quality statement 3.

Quality measures

Structure

Evidence of local arrangements to ensure that people who test positive for HBsAg are referred to specialist care for further assessment.

Data source: Local data collection.

Process

a) Proportion of adults (aged 18 years and over) who test HBsAg‑positive who are referred to specialist care for further assessment.

Numerator – the number in the denominator who are referred to specialist care for further assessment.

Denominator – the number of adults (aged 18 years and over) who test HBsAg‑positive.

Data source: Local data collection. NICE Hepatitis B: clinical audit tool – primary care, audit standard 2.

b) Proportion of children and young people (under 18 years) who test HBsAg‑positive who are referred to specialist care for further assessment.

Numerator – the number in the denominator who are referred to specialist care for further assessment.

Denominator – the number of children and young people (under 18 years) who test HBsAg‑positive.

Data source: Local data collection. NICE Hepatitis B: clinical audit tool – primary care, audit standard 3.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (GP practices, prisons and immigration removal centres, drug services and secondary care providers of sexual health and genitourinary medicine clinics) ensure that local referral pathways are in place and that people who test positive for HBsAg are referred to specialist care for further assessment.

Healthcare professionals refer people who test HBsAg-positive to specialist care for further assessment.

Commissioners (local authority commissioners, NHS England area teams and clinical commissioning groups) work with providers of testing and vaccination services to ensure that people who test HBsAg-positive are referred to specialist care for further assessment.

Clinical commissioning groups work with partners in secondary care to ensure that specialist services provide further assessment for people who test HBsAg-positive.

What the quality statement means for patients, service users and carers

People who are found to have hepatitis B infection are referred to a specialist for further assessment.

Source guidance

Definitions of terms used in this quality statement

Specialist care

  • Adults who test HBsAg-positive are referred to a hepatologist, or to a gastroenterologist or infectious disease specialist with an interest in hepatology.

  • Children and young people who test HBsAg-positive are referred to a paediatric hepatologist, or to a gastroenterologist or infectious disease specialist with an interest in hepatology. [NICE clinical guideline 165, recommendations 1.2.2 and 1.2.7]