Quality standard
Quality statement 6: Monitoring people with chronic hepatitis B infection who do not meet the criteria for antiviral treatment
Quality statement 6: Monitoring people with chronic hepatitis B infection who do not meet the criteria for antiviral treatment
Quality statement
People with chronic hepatitis B infection who do not meet the criteria for antiviral treatment are monitored regularly at intervals determined by their infection status and age.
Rationale
Monitoring starts shortly after a person is diagnosed with chronic hepatitis B infection. For people who do not need antiviral treatment, continuous follow-up is needed to determine the stage of infection, whether treatment needs to be started and if they are at risk of developing fibrosis.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people with chronic hepatitis B infection who do not meet the criteria for antiviral treatment are monitored regularly at intervals determined by their infection status and age.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example from service pathways or protocols.
Process
Proportion of people with chronic hepatitis B infection who do not meet the criteria for antiviral treatment who are monitored regularly at intervals determined by their infection status and age.
Numerator – the number of people in the denominator who are monitored regularly at intervals determined by their infection status and age.
Denominator – the number of people with chronic hepatitis B infection who do not meet the criteria for antiviral treatment.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (hospital-based specialist care) ensure that competent healthcare professionals are in place to meet the commissioned levels of activity through outpatient clinics.
Healthcare professionals ensure that people with chronic hepatitis B infection who do not meet the criteria for antiviral treatment are monitored regularly at intervals determined by their infection status and age.
Commissioners (clinical commissioning groups and hospital-based specialist care providers) ensure that systems and facilities are in place for monitoring and follow-up of people with chronic hepatitis B who do not meet the criteria for antiviral treatment.
People with chronic hepatitis B infection (infection that has lasted for 6 months or more) who do not meet the criteria for antiviral treatment are monitored regularly to check the stage of the infection, whether they need to start treatment and if they are at risk of developing fibrosis (scarring of the liver).
Source guidance
Hepatitis B (chronic): diagnosis and management. NICE guideline CG165 (2013, updated 2017), recommendations 1.6.1 to 1.6.8
Definitions of terms used in this quality statement
Chronic hepatitis B infection
Chronic hepatitis B infection is defined as persistence of hepatitis B surface antigen (HBsAg) for 6 months or more after acute infection with hepatitis B virus. Chronic hepatitis B infection can be divided into e antigen (HBeAg)-positive or HBeAg-negative disease based on the presence or absence of e antigen. The presence of HBeAg is typically associated with higher rates of viral replication and therefore increased infectivity. [NICE's guideline on hepatitis B (chronic)]
Recommended intervals for monitoring
Monitoring intervals for people who do not meet the criteria for antiviral treatment are outlined in NICE's guideline on hepatitis B (chronic). These vary with infection status and age, and include:
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Adults with HBeAg-positive disease in the immune-tolerant and immune-clearance phases (recommendations 1.6.1 and 1.6.2).
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Adults with inactive chronic hepatitis B (immune-control phase; recommendation 1.6.3).
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Children and young people (recommendations 1.6.4 to 1.6.6).
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Children, young people and adults with HBeAg or HBsAg seroconversion after antiviral treatment (recommendations 1.6.7 and 1.6.8).
Monitoring people with chronic hepatitis B infection who meet the criteria for antiviral treatment
Monitoring intervals for people who meet the criteria for antiviral treatment are outlined in NICE's guideline on hepatitis B (chronic). These vary with infection status, age and clinical status. [NICE's guideline on hepatitis B (chronic), recommendations 1.5.1 to 1.5.53]
Equality and diversity considerations
The information on monitoring people (including children, young people and adults) with chronic hepatitis B infection who do not meet the criteria for antiviral treatment should be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Adults receiving information should have access to an interpreter or advocate if needed. The information should be tailored to the age of the person.