- 期刊
配合執行國家消除C肝政策綱領：馬偕紀念醫院之經驗分享
Strategy and Policy for Hepatitis C Virus Elimination: Experience in MacKay Memorial Hospital
摘要
2016年的世界衛生大會中，提出在2030年前消除病毒性肝炎的目標。稍後我國也訂出“國家消除C肝政策綱領＂，朝2025年根除C型肝炎努力。本文分享了馬偕紀念醫院為配合國家政策，在C型肝炎防治上所做的事工。本院於2022年成立院層級之C型肝炎防治工作小組，組成跨科與跨職系團隊，提昇與擴大C型肝炎篩檢、轉介、治療及追蹤相關事工。在醫師、資訊室與檢驗科的合作，符合法規與資安前提下，本院運用Power BI系統，共同開發出可估算C型肝炎篩檢與治療的需求量之資訊儀表板介面。工作小組依據這些資訊，規劃制定院內篩檢、轉介與後續監測之對策。透過醫師、資訊室與醫事室合作，在門診醫療資訊系統建置彈跳視窗提示，當設定需要篩檢的病人就診時，提醒醫師是否同意或需要接受C型肝炎篩檢。在病人同意後，門診醫療資訊系統還可自動將彈跳視窗中相關臨床資訊、診斷碼及篩檢醫令，記錄在電子病歷中，提升紀錄完整性，降低病歷抽審相關問題。本院除配合國健署推廣成健病毒性肝炎篩檢，也在門診對高危險族群以醫療資訊系統進行彈跳視窗提示（如糖尿病、早期慢性腎病、末期腎病病人、毒癮病人、HIV感染者）之外。同時，本院也針對院內員工進行全面與複數次C肝普篩，朝向無C肝職場環境努力。為提升C型肝炎診治的效率與品質。及減少病人多次就診與等待報告之流失，在醫事室與檢驗科合作下，建立了本院之HCV reflex testing；搭配護理部協助建置，落實門診全時段綠色通道，可讓病人快速轉介胃腸肝膽科，完成後續診療與追蹤的病人，提升C型肝炎完治比例。本院護理部與社區醫學中心，亦在院內及社區以團體衛教、海報及網路等方式傳遞，舉辦多場病毒性肝防治宣導活動，提高肝炎篩檢政策的曝光度。未來本院仍將持續配合國家與衛生主管機關，擴大落實消除C肝政策綱領之相關政策，朝著國家消除C肝之政策加速邁進。
並列摘要
In the World Health Assembly of 2016, a goal was set to eliminate viral hepatitis by 2030. Our country established the "National Hepatitis C Elimination Policy Program" to strive for the eradication of Hepatitis C virus (HCV) by 2025. This article shares the efforts made by MacKay Memorial Hospital(MMH)to align with national policies in HCV elimination. In 2022, MMH established HCV prevention and treatment task force, comprising multi-disciplinary team to enhance screening, referral, treatment and follow-up program. In collaboration with clinicians, information technology office and laboratory department, MMH utilized the Power BI system to develop an information dashboard interface capable of estimating the demand for Hepatitis C screening and treatment. Based on Power BI information, the task force formulated multiple informative strategies for HCV. MMH had established intelligent pop-up window in the outpatient(OPD)HIS to remind physicians whether patients who require HCV screening are visiting. In addition to viral hepatitis screening promoted by National Health Administration, high-risk groups such as abnormal liver function test, diabetes, early-stage chronic kidney disease, end-stage kidney disease, dialysis, substance abuse, and HIV infection were enrolled for screening. Upon patient consent, the HIS of OPD can automatically record relevant clinical information, ICD-10 codes, and orders into the electronic medical record. At the same time, we'd conducted multiple rounds of Hepatitis C screening for our staff, aiming for a Hepatitis C-free workplace. To reduce patient loss due to multiple visits and waiting for reports, HCV reflex testing was established. With the assistance of the nursing department, a green channel for OPD services was implemented, allowing patients to be quickly referred to the GI OPD for further diagnosis and treatment. The nursing department and the community health center also conducted multiple viral hepatitis education activities both in MMH and community through group education, posters, and online platforms to raise awareness of hepatitis screening policies. In the future, MMH will continue to cooperate with national and health authorities to expand the implementation of policies related to the elimination of Hepatitis C, accelerating progress toward the national goal of Hepatitis C elimination.