| Background and objective:HBV(Hepatitis B virus)infection is prevalent worldwide.It is estimated that in2015,the global HBs Ag positive rate was about 3.9%,and 257 million people were chronic HBV infections(defined as HBs Ag and / HBV DNA positive for more than 6months),but only about 10% of these patients were diagnosed,while only 5% of patients who met the antiviral treatment criteria actually received standard treatment.The diagnosis and treatment of hepatitis B infection in China is also not optimistic.In2016,19% patients with hepatitis B in China were diagnosed,and about 10% of CHB patients were receiving antiviral treatment,of which only 1% of HBV patients achieved functional cure.I t is a pity that many hepatitis B patients were diagnosed with liver cirrhosis or even liver cancer for the first time.Carrying out a national census or hepatitis B screening in high-risk groups can find more patients in need of treatment,but it requires huge health resources,which is a challenging task for all countries.At present,our country mainly carries out HBV screening for the following groups: blood donors,premarital screening,inpatients before invasive examination,surgery and blood transfusion.According to the report of the Health Statistics Yearbook,the total number of inpatients due to various causes in China was about 227 million in 2016,of which a large number of inpatients were screened for blood-borne infectious diseases,such as HBV,hepatitis C virus,(Hepatitis C virus,HCV),(Human immunodeficiency virus,HIV),and syphilis,from which a large number of HBV infections can be found.Unfortunately,these patients have not received systematic health education and management.On the one hand,it wastes valuable medical resources,on the other hand,it delays the patient’s condition.Screening and timely referral of hepatitis B patients in hospital is the most economical and convenient way to find patients with hepatitis who needed to treat,and the additional medical investment is small.But the development of this part of work at home and abroad is not optimistic.This study takes hepatitis B screening of inpatients as a starting point to explore the referral and management strategies of hepatitis B patients in hospital in China,in order to provide a feasible model for domestic counterparts.Methods:Statistics of the total number of inpatients in our hospital from May 10,2019 to December 31,2020,We collected the number of hepatitis B infection markers and the positive rate of hepatitis B screening.By using the convenient sampling method,HBs Ag(+)patients with non-hepatology diseases were found in the nosocomial infection surveillance system,and their health education was carried out and referrals were completed.Results:During the period from May 10,2019 to December 31,2020,the total number of inpatients in the hospital was 330,366,the total number of people screened for hepatitis B infection markers was 121,456,the overall screening rate was 36.76%,of which the total number of HBs Ag(+)was 7,141,the positive rate was 5.88%;the number of inpatients in non-hepatology disease department was 323,558,the number of screening HBs Ag was 118,401,the screening rate was 36.59%,the number of inpatients in liver disease department was 6,808,the number of screening HBs Ag was3,055,and the screening rate was 44.87%.Since patients with hepatitis B virus infection in the hepatology department in the hospital have been well managed,We selected1,534 non-hepatology HBs Ag(+)patients by convenient sampling method to study their referral status.Affected by the pandemic of COVID-19,772 HBV-infected patients could not receive health education by doctors in the hepatology department and were set as the non-health education group;During the hospitalization period of the remaining 762 non-hepatology HBV infected patients,additional hepatologists will conduct one-on-one hepatitis B health education,and guide them to referral,and set them as the health education group.Firstly,using the statistical method of two independent samples t-test,it was found that there was no statistical difference between the two groups in terms of age,gender,and whether they were hospitalized in relevant departments of internal medicine.In the health education group,the referral rate during hospitalization was 40.3%(307/762),and increased to 61.3%(467/762)6-12 months after discharge;in the non-health education group,the referral rate was 38.3%(296/772),and increased to 46.6%(360/772)6-12 months after discharge.During the hospitalization,there was no significant difference in the referral rate between the health education group and the non-health education group(40.3%vs38.3%,c2=0.609,P=0.435).6-12 months after discharge,there was a significant difference in the referral rate between the two groups(61.3%vs46.6%,c2=33.142,P=0.001).Secondly,we collected successful referrals of the two groups and divided them into 9 groups according to age,which were 0-10 years old,11-20 years old,21-30 years old,31-40 years old,41-50 years old,51-60 years old,61-70 years old,71-80 years old,81-90 years old.We found that there were statistical differences in the referral rate between different age groups(c2=21.137,P <0.05),and the two groups with higher referral rates were both in the 31-70-year-old group;At the same time,the success of referrals was not related to gender(c2=0.210,P=0.647).The referral rate of patients with HBV infection in the non-hepatology department is different between the internal medicine-related departments and non-internal medicinerelated departments(c2=19.273,P <0.001);There are differences in the referral rate of HBV-infected patients in non-hepatology departments between internal medicinerelated departments and non-internal medicine-related departments(c2=19.273,P<0.001);Among male patients,patients with alanine transaminase(ALT)level >50U/L have a higher referral rate(66.87% vs.51.57%,P=0.001).Conclusion:1.The screening rate of hepatitis B infection markers for inpatients in our hospital is 36.76%,The referral rate of HBV infection is low.2.Health education for HBs Ag(+)patients by hepatology doctors can improve the referral rate of hepatitis B patients significantly.3.Non-hepatologists play an important role in increasing the referral rate of HBVinfected patients. |
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