Shared learning database

NI Regional Hepatitis B&C Managed Clinical Network
Published date:
November 2012

Intervention to reduce the drop-off between those patients newly diagnosed with Hepatitis C in Northern Ireland and those referred for assessment.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

-To determine the size of Gap between those testing PCR positive for Chronic Hepatitis C (CHC) and those being referred for assessment.

-To close the Gap between those testing positive and those referred.

Reasons for implementing your project

A 2002 audit of Chronic Hepatitis C (CHC) positive cases identified in Northern Ireland (NI) since 1991, showed that a large proportion of patients with a positive hepatitis C test have never been referred for consideration of treatment. More recently, we have shown that at least 25% of the positive CHC cases detected in NI were not referred to the regional treatment service. Following the establishment of the NI Hepatitis B&C Managed Clinical Network (MCN), in an attempt to reduce the gap between diagnosis and treatment of CHC, all newly confirmed CHC polymerase chain reaction (PCR) positive cases have and will be followed up as to whether referral has been made for specialist assessment/treatment.

How did you implement the project

Following establishment of the MCN, CHC Referral Guidelines for Primary Care were sent to every GP in Northern Ireland to heighten the awareness of the disease along with a letter informing them that the MNC would be prospectively following up on every HCV PCR positive result where there appeared to be no record of referral.

Between September 2009 and June 2012, all new cases of HCV PCR+ve were cross-referenced against lab-centre and new referrals to the Royal Victoria Hospital (RVH) for assessment of CHC. In the event of non-referral or evidence that the individual was not being reviewed elsewhere in the province by a gastroenterologist with a specific interest in viral hepatitis; the originator of the positive test was contacted with copy of results and the referral guidelines and a letter asking them to review their records to ascertain if the individual with the positive CHC result but been referred to the Royal Victoria Hospital or to an Gastroenterologist at a local hospital. If no referral or correspondence was received after 8 weeks, a second letter was sent out, and if still no reply, the originator of test was contacted by the Network Manager, using a pre-scripted phone call, approved by the MCN.

For initial barriers encountered, please see the supporting material.

Key findings

Between September 2009 and June 2012, 219 CHC PCR positive cases were confirmed. Of these 219, cross-referencing showed that referrals were received for 118 cases (54%). After follow-up, a further 75 referrals were received (34%). An additional 4 patients (1.8%) were deceased. With respect to the remaining 22 cases (10%), 5 had moved from NI, 4 were receiving CHC follow up elsewhere in NI, 3 had declined further assessment and the remaining 10 were lost to follow up. This means that there are 18 (8%) cases that were never referred for various reasons.

There are currently no other outstanding referrals for the Sept 2011 to June 2012 (22 months), with exception of those who where lost to follow up or refusing treatment at this present time. This leaves the total figure for non referrals rate and those possibly not attending for specialist assessment of their HCV status, for Sept 2009 to June 2012 (22 months) at 18 (8 %). Considering the nature of the client, 8% is considered more than acceptable.

Key learning points

- Intervention of MCN resulted in 92% of PCR positive cases from 2009-2012 being referred
- Referral rate in first half of 2012 WITHOUT intervention is 79% (cf 42% in 2010)
- Currently there is 100% follow up of all HCV PCR+ laboratory diagnosed cases in Northern Ireland. The involvement of the NI Hepatitis B&C MCN has dramatically increased the number of CHC positive patients being referred for assessment of their CHC status, thereby improving the overall outcome for these individuals.

Contact details

Annelies McCurley
NI Hepatitis B&C MCN Manager
NI Regional Hepatitis B&C Managed Clinical Network

Secondary care
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