Hepatitis B s100 Community Prescriber Program...Hepatitis B s100 Community Prescriber Program - A Guide for General Practitioners 5 2.6 Continuing professional development Hepatitis

Hepatitis B s100 Community Prescriber ProgramA Guide for General Practitioners

Training | Accreditation | Prescribing | Maintenance

Supporting the HIV, Viral Hepatitis and Sexual Health Workforce

Hepatitis B s100 Community Prescriber Program - A Guide for General Practitioners 2

Contents

1.0 Introduction...............................................................................................................................................................................................3

2.0 Eligibility criteria for accreditation....................................................................................................................................................3

Figure 1: Overview of the initial accreditation process.................................................................................................4

2.1 ASHM Hepatitis B s100 Prescriber Course...................................................................................................................4

2.2 Application for HBV Prescribing......................................................................................................................................4

2.3 Case assessment...................................................................................................................................................................4

2.4 Formal authorisation...........................................................................................................................................................4

2.5 Approvals process for initiation of first five patients on treatment....................................................................4

2.6 Continuing professional development.........................................................................................................................5

3.0 Directory.....................................................................................................................................................................................................5

4.0 Prescribing processes............................................................................................................................................................................5

4.1 Troubleshooting...................................................................................................................................................................5

5.0 Maintenance of accreditation.............................................................................................................................................................5

5.1 How to earn CPD points....................................................................................................................................................6

Table 1: Mentoring HBV CPD Activity...............................................................................................................6

Table 2: Other HBV CPD Activities.....................................................................................................................6

5.2 Adjudication of HBV CPD points....................................................................................................................................7

For HBV Community Prescribers.......................................................................................................................7

For training providers............................................................................................................................................7

5.3 Accreditation renewal timeline......................................................................................................................................7

5.4 Recording and reporting CPD activity.........................................................................................................................7

Appendices......................................................................................................................................................................................................8

Appendix 1: Program background.......................................................................................................................................9

Appendix 2: Application for HBV Prescribing..................................................................................................................10

Appendix 3.1: Pro Forma for initiation of first 5 patients on treatment.................................................................13

Appendix 3.2: Pro Forma Guidelines....................................................................................................................................18

Appendix 4: HBV CPD self-adjudication form..................................................................................................................19

Appendix 5: HBV CPD activities delivered by external providers.............................................................................21

Appendix 6: Provider Adjudication Form..........................................................................................................................22

Appendix 7: Attendance Form..............................................................................................................................................25


1.0 IntroductionThis guide contains information about the training, accreditation, and maintenance of Hepatitis B S100 Community Prescribers for the

jurisdictions where ASHM has a formal accreditation arrangement with the respective health departments.

See Appendix 1: Program background for further information

2.0 Eligibility criteria for accreditationGeneral practitioners and community-based medical practitioners applying for authority to prescribe s100 drugs as treatment of HBV must

fulfil the following three criteria:

1. Complete an accredited hepatitis B prescriber training course, or get recognition of prior knowledge (see section 2.2).

2. Access appropriate support from senior clinicians working in a designated liver clinic treatment unit in a public hospital, and access

other clinic staff and services.

3. Complete an 'Application Form for HBV Prescribing', nominating at least one specialist to be linked with

(see section 2.2 and appendix 2).

4. Commit to ongoing HBV-specific continuing professional development (CPD) (see section 5.0).

Figure 1: Overview of the initial accreditation process

Completion of Hepatitis B s100 Prescriber Course Or recognition of prior experience

Complete application form for HBV Prescribing (confirming link with a specialist active in HBV treatment)

Complete online case assessments within 6 weeks of course

Pass or given feedback and an opportunity to re-sit case assessment

ASHM informs Department of Health who sends an agreement form to individual prescribers to be signed and returned

Formal authorisation to prescribe s100 drugs for the treatment of hepatitis B

A pro forma is completed for the first 5 patients initiated on treatment. The decision to initiate is approved by the linking specialist.

Commit to ongoing HBV-specific continuing professional development

See ACT Health process.

See NSW Ministry of Health process.

See Northern Territory Government Department of Health process.

See Department for Health and Ageing, Government of South Australia process.

http://www0.health.nsw.gov.au/policies/pd/2013/pdf/PD2013_055.pdf

http://www0.health.nsw.gov.au/policies/pd/2013/pdf/PD2013_055.pdf

http://www.ashm.org.au/Documents/SA%20Health%20S100%20process%20for%20SA%20HIV-HBV-HCV_FINAL.pdf


2.1 ASHM Hepatitis B s100 Prescriber CourseASHM’s course “Hepatitis B s100 Prescriber Course” meets the national standard for the training of general practitioners and community-

based medical practitioners applying for authority to prescribe s100 drugs for the treatment of HBV. The 1.5-day course provides the

foundation for the accreditation process. The course is free to residents of the state in which the course is run. Out-of-state practitioners may

attend by paying a course fee - scholarships may be available from their state health department.

Upcoming dates for “Hepatitis B s100 Prescriber Course” can be found on ASHM’s course page at www.ashm.org.au/courses. Interested

practitioners can also e-mail [email protected] to be placed on an interest list and notified when the course is happening in their area.

2.2 Application Form for HBV PrescribingPractitioners who attend “Hepatitis B s100 Prescriber Course” must submit an application form for HBV Prescribing to ASHM to indicate

their intention to become Hepatitis B s100 Community Prescribers (see appendix 2 for a copy of this form). The form asks applicants to

nominate a senior clinician at a HBV treatment centre or liver clinic who will serve as the applicant’s mentor (also known as the “linking

specialist”). Applicants may also ask ASHM to link them with a mentor if they do not have a current relationship with one.

2.3 Case assessmentPractitioners interested in becoming accredited to prescribe s100 drugs for HBV treatment must successfully pass a set of 5 online multiple

choice question case assessments that are distributed following completion of the Hepatitis B s100 Prescriber Course. These cases are

designed to assess capacity to:

• Screen at risk patients appropriately, describe the tests involved in the diagnosis of chronic hepatitis B infection and assess phase of the

disease

• Monitor patients with chronic hepatitis B appropriately, establish suitability for treatment and refer for specialist care if indicated

• Discuss aims of treatment, antiviral treatment options for HBV infection including duration of therapy and definitions of response

• Monitor patients on HBV antiviral therapy according to established treatment protocols, recognize and manage resistance, hepatitis

flares and response

• Recognize risk factors, clinical signs, symptoms and complications of advanced liver disease and manage or refer to specialist

appropriately

The case studies must be completed no later than 6 weeks following completion of the Hepatitis B S100 Prescriber course.

Where the multiple choice questions are answered incorrectly, candidates will be given feedback comments and directed to further reading

before being able to re-sit the assessment. There is an opportunity for candidates to discuss their answers with a clinical advisor if needed.

Participants must receive a passing mark for all five case studies to pass the case assessment. Those who do not meet the necessary standard

will be invited to re-sit the assessment.

2.4 Formal authorisationCandidates who have fulfilled the first three criteria set out in section 2, including successful completion of their case assessment, will be

recommended by ASHM to the state for the authorisation to provide s100 drugs for the treatment of HBV.

Practitioners will receive written confirmation from the state when their authorisation is complete.

2.5 Approvals process for initiation of first five patients on treatmentHepatitis B S100 Community Prescribers may now write initiation scripts for patients in their care. For the first 5 patients to be initiated on to

treatment, the accredited prescriber must complete a pro forma document (see example with instructions for completion, in appendices

3.1 and 3.2). This pro forma must be sent to their linking specialist for approval prior to initiation of treatment to ensure the decision to start

treatment is appropriate.

www.ashm.org.au/courses

mailto:education%40ashm.org.au%20?subject=education


2.6 Continuing professional developmentHepatitis B s100 Community Prescribers are required to participate in continuing professional development (CPD) relevant to the

management of hepatitis B to maintain accreditation to prescribe s100 HBV drugs in Australia. The aim of this is to ensure that Hepatitis B

S100 Community Prescribers maintain their clinical competencies in hepatitis B. This program is described in more detail in section 5.0.

3.0 DirectoryASHM publishes a directory of accredited Hepatitis B S100 Community Prescribers in ACT, NSW, NT, SA and WA on its website.

Practitioners who do not wish to be included on this list may opt out at any time.

4.0 Prescribing processesAs of 1st July 2015, practitioners who are accredited to prescribe s100 HBV treatment are authorised to initiate treatment. Previously,

Hepatitis B S100 Community Prescribers could only write maintenance prescriptions after treatment had been initiated by a specialist.

Hepatitis B S100 Community Prescribers are still required to prescribe in accordance with PBS restriction criteria and keep evidence of

compliance and patient eligibility on patient records. To prescribe a medicine under these arrangements, a prescriber is required to include

the STREAMLINED authority code on the authority prescription.

Authority required (STREAMLINED) items don’t require telephone or written approval from DHS or DVA prior to prescribing.

Instead, doctors are required to include a streamlined authority code on the authority prescription. However, to prescribe quantities and/or

additional repeats above those specified in the PBS schedule, the item will be treated as an Authority required item.

See http://www.pbs.gov.au/info/publication/factsheets/shared/fact-sheet-streamlined-authorities.

Streamlined authority items are identified in the PBS Schedule with the heading ‘Authority required (STREAMLINED)’.

A pre-determined, 4-digit streamlined authority code applies to each restriction for a streamlined authority item.

• To prescribe a STREAMLINED authority item, a prescriber is required to include the streamlined authority code on the authority

prescription. By doing so, the prescriber is acknowledging that they are eligible to prescribe the item under the Pharmaceutical Benefits

Scheme, and that the use of the medicine complies with the PBS subsidy restrictions applying on the date of prescribing.

• STREAMLINED authority codes are listed in the PBS Schedule. The schedule is available on www.pbs.gov.au. Prescribing software also

includes streamlined authority codes.

• Telephone-based PBS Authority approval will still be required prior to prescribing increased PBS quantities and/or increased repeats.

• See http://vimeopro.com/ashm/prescribing-using-streamlined-authority-codes for a video tutorial on how to write a streamlined

authority prescription.

HBV s100 drugs are now also able to be dispensed in community pharmacies regardless of whether the drugs were prescribed by a hospital-

based specialist or an accredited GP in the community. However, some community pharmacies may not have a stocked supply of HBV s100

drugs and instead will fill HBV s100 scripts on a just-in-time basis. Hepatitis B S100 Community Prescribers are advised to recommend to

patients to get scripts filled a week before they run out of pills and/or confirm with the pharmacy that they have drugs in stock.

4.1 TroubleshootingHepatitis B S100 Community Prescribers who experience any problems in writing a prescription, or in having the medication dispensed can

contact ASHM for support. Contact [email protected] or 02 8204 0769.

5.0 Maintenance of accreditationTo maintain their accreditation as Hepatitis B S100 Community Prescribers, practitioners must accrue a total of 3 HBV continuing

professional development (CPD) points during each calendar year. At least one of these HBV CPD points must be gained through a

mentoring activity with your nominated linking specialist.

To support practitioners in maintaining their accreditation, ASHM conducts a range of CPD activities including HBV prescriber updates,

other training courses in viral hepatitis, webinars and online CPD activities.

http://www.ashm.org.au/HBV/hbv-prescriber-lists

http://www.pbs.gov.au/info/publication/factsheets/shared/fact-sheet-streamlined-authorities

www.pbs.gov.au

http://vimeopro.com/ashm/prescribing-using-streamlined-authority-codes

mailto:HBVprescriber%40ashm.org.au?subject=HBV%20prescriber

www.ashm.org.au/HBV/training


5.1 How to earn CPD pointsCPD points can be accrued by primary care practitioners through a variety of education and training activities delivered both by ASHM and

by external CPD providers. Registrants at all activities delivered by ASHM are recorded, but it is the responsibility of the attendee to sign the

attendance sheet to claim HBV CPD points. External HBV CPD providers should apply prospectively and submit attendance sheets to ASHM

in order for the HBV CPD points for primary care practitioners attending that activity to be recorded.

Similar to guidelines for RACGP accredited activities, non-interactive or didactic learning generally attracts less HBV CPD points per session

than interactive learning. Cultural Awareness Training, liver health or advanced liver disease CPD could also contribute to HBV.

CPD if the activity has been accredited. For a detailed breakdown of the points awarded to specific activities, please refer to the HBV CPD

Points Award Table below. It is recommended that primary care practitioners participate in a range of activities to obtain their CPD points.

Table 1: Mentoring HBV CPD ActivityIt is mandatory to obtain at least 1 CPD point from this table.

HBV CPD Activity HBV CPD points Documentation needed

Case Conferencing regarding HBV management issues with a HBV Specialist

1 point per hourPrescriber provides proof of activity to ASHM staff or ASHM staff can check points claimed with specialist

Mentoring activity with Hospital HBV Specialist (eg. Observation and/or discussion of prescribers cases, attendance of clinical review meetings)

1 point per 2hrPrescriber provides proof of activity to ASHM staff or ASHM staff can check points claimed with specialist

Clinical placement at a HBV Treatment Centre2 points per 4hr placement per year

Placement organized by prescriber & prescriber provides short summary of learning outcome(s) of placement to ASHM staff

Note: all activities can either occur face-to-face or via telephone/skype etc

Table 2: Other HBV CPD Activities

HBV CPD Activity HBV CPD points Documentation needed

Completion of Modules in ASHM Hepatitis B s100 Prescriber Course or equivalent from other provider

1 point per moduleASHM course attendance recorded by ASHM staff; other courses need certificate of completion

Attendance at ASHM HBV Prescriber update/case discussion meeting

1 points per meeting, maximum 2 per year

ASHM meeting attendance recorded by ASHM staff

Clinical audit regarding HBV management

1 points per auditPrescriber provides short report on outcome of audit to ASHM staff

Presentation at ASHM course or other HBV CPD accredited event

1 point per eventASHM courses recorded by ASHM staff; other courses need copy of program and evaluation from provider

Participation as an investigator in a HBV clinical trial

1 point per trial per yearConfirmation of participation from principal investigator in trial

Publication of journal article related to HBV

2 points per article if 1st author; 1 point if not

Copy of journal article

Attendance at a recognised Conference with a HBV focus

1 point per day, maximum 2 points per event

Copy of certificate of attendance or record of attendance kept by ASHM staff

Online HBV CPD units with Medscape, Clinical Care Options or other CPD providers

1 point per unit Copy of certificate of completion

Completion of peer-reviewed Journal HBV CPD exercise

1 point per unit, maximum 1 per year

Copy of certificate of completion

Attendance at HBV Clinical Update from other CPD provider

As per HBV CPD pointsaward for activity

CPD provider will provide attendance list to ASHM if event is CPD accredited


5.2 Adjudication of HBV CPD pointsBoth external training providers and Hepatitis B S100 Community Prescribers can apply to ASHM for adjudication of HBV CPD educational activities

For HBV Community Prescribers

Hepatitis B s100 Community Prescribers are able to submit any relevant completed activities for adjudication, using the HBV CPD self-adjudication form (see appendix 4). Please submit these forms on an ongoing basis, as activities are completed throughout the calendar year. ASHM's Clinical Advisors will adjudicate each activity on behalf of the National Clinical Standards and Accreditation Panel and award CPD points accordingly.

For Training Providers

ASHM actively encourages external education providers to submit their HBV CPD activities for adjudication (see appendix 5 for further information). We welcome additional opportunities for Hepatitis B s100 Community Prescribers to achieve their HBV CPD points. Please complete the Provider Adjudication Form (see appendix 6) and the Attendance Form (see appendix 7) to commence the process

with ASHM.

5.3 Accreditation renewal timeline

October

ASHM sends Community Prescribers a personalised HBV CPD record sheet listing all known CPD activities they have completed since 1 January of that year.

Community prescribers are sent an annual prescriber survey, which includes re- confirming the details of their current practice and their linking HBV specialist.. This is mandatory to complete as part of the renewal process.

Community Prescribers who have not reached minimum CPD requirements are informed about both ASHM and external activities that will attract CPD points during the remainder of the year.

December

Community Prescribers are notified in writing whether or not they have met all the necessary requirements to maintain accreditation for the following calendar year.

Prescribers who have not reached minimum CPD requirements and/or completed the annual prescriber survey, are actively encouraged and supported by ASHM to complete additional CPD activities by 31 March.

March

Community Prescribers have their accreditation formally renewed and their detailsmaintained in the HBV Community Prescriber register provided they: 1. meet all CPD requirements;2. complete the annual prescriber survey; and3. maintain their established link with an appropriate HBV specialist or treatment facility.

5.4 Recording and reporting CPD activityHepatitis B S100 Community Prescribers will be sent a personalized HBV CPD record sheet in the fourth quarter of each calendar year. The record sheet will list all activities that ASHM secretariat staff are aware the practitioner has completed since 1 January of that year. These may be a combination of ASHM activities and those delivered by external providers, provided that the external provider has supplied ASHM with attendance records.

Hepatitis B S100 Community Prescribers will also be given an opportunity to detail learning activities they have undertaken not yet accredited for HBV CPD. Prescribers must provide adequate details regarding the activity and the learning outcomes in order for that activity to be considered for HBV CPD points. Prescribers may be expected to provide evidence of an activity given by an external HBV CPD provider such as a certificate of completion.

The aim of the HBV CPD program is to ensure primary care practitioners maintain their clinical competency and are kept up to date. It is not intended to be punitive. ASHM secretariat staff will assist primary care practitioners to access further training and other CPD activities as necessary to accrue their remaining HBV CPD points.

Appendices

Appendix 1: Program background................................................................................................9

Appendix 2: Application for HBV Prescribing...........................................................................10

Appendix 3.1: Pro Forma for initiation of first 5 patients on treatment.............................13

Appendix 3.2: Pro Forma Guidelines...........................................................................................18

Appendix 4: HBV CPD self-adjudication form...........................................................................19

Appendix 5: HBV CPD activities delivered by external providers........................................21

Appendix 6: Provider Adjudication Form..................................................................................22

Appendix 7: Attendance Form......................................................................................................25

Hepatitis B s100 Community Prescriber Program - A guide for General Practitioners 9

Appendix 1: Program background

The audience for this guide is:

• Medical practitioners who wish to be accredited to prescribe s100 drugs for the treatment of hepatitis B virus (HBV);

• Medical practitioners who are authorised to provide HBV s100 therapy, and who wish to maintain and renew their accreditation;

• Prospective participants in “Hepatitis B s100 Prescriber Course,” including general practitioners who wish to prescribe therapy for HBV in other Australian jurisdictions not yet included in the program.

The secondary audience for this guide is:

• Authorities interested in similar programs or in other areas of public health, such as hepatitis and sexual health;

• Medical practitioners in New Zealand and other countries in the region who are interested in training for treatment of HBV.

Section 100 of the National Health Act 1953 (Commonwealth) provides for the Australian Health Minister to make special arrangements to provide an adequate pharmaceutical service to persons “who are receiving medical treatment in such circumstances that the pharmaceutical benefits provided for by this Part cannot be conveniently or efficiently supplied in accordance with the general provisions of this Part.” This is the legislative basis for the Highly Specialised Drugs (HSD) Program of the Commonwealth Department of Health and Ageing, through which the Commonwealth provides funding to the states and territories for certain drugs for chronic conditions which, because of their clinical use or other special features, are normally restricted to supply through hospitals having access to appropriate specialist facilities.

Medical practitioners who are hospital-based or in general practice, and who are not specialists affiliated with hospitals having appropriate specialist facilities, may apply for authority to prescribe HSD drugs for HBV. The state/territory health authorities give approval on an individual basis. In New South Wales, South Australia, The Northern Territory, and the Australian Capital Territory, a decision to give that authorisation is made on the basis of an assessment that the applicant meets national standards of certification (see section 2.0). The accrediting agency in these jurisdictions is ASHM. Other Australian jurisdictions do not have a formal arrangement with an accrediting agency.

Authorised HSD prescribers (also known as s100 prescribers) are required to maintain and update their knowledge by participating in continuing professional development (CPD) activities. In order to maintain their prescriber authorisation, prescribers are required to collect HBV CPD points during each calendar year (see section 5.0). Monitoring and re-accreditation is undertaken by the accreditation

agency, ASHM.

LMB 5057 Darlinghurst NSW 1300 Australia, Level 7, 46–56 Kippax Street, Surry Hills NSW 2010 AustraliaT +61 2 8204 0700 | F +61 2 9212 2382 | E [email protected] | W www.ashm.org.au

10

Name

Current Primary Practice Practice Name:

Practice Address:

ASHM publishes the above practice information for HBV prescribers via a directory on its website. Please check here if you would prefer NOT to be listed in this directory once accredited

Note: Please provide ASHM with at least one email address.

Antiviral treatments for chronic hepatitis B are Highly Specialised Drugs.

A general practitioner non-specialist hospital doctor may only prescribe Highly Specialised Drugs under the guidance of a treating specialist.

Other Practices and Locations (if in the future please state planned date of commencement)

Postal address

Telephone (work)

Mobile

Fax

Email (work)

Email (personal)

Application Form for HBV Prescribing

Collaborative care arrangement between community practitioner and specialist/specialist service

Note: Please complete this form electronically

I am a GP and wish to provide HBV treatment under the guidance of the treating specialist of HBV infection in

New South Wales

Australian Capital Territory

Victoria

Western Australia South Australia

Queensland

Northern Territory

LMB 5057 Darlinghurst NSW 1300 Australia, Level 7, 46–56 Kippax Street, Surry Hills NSW 2010 AustraliaT +61 2 8204 0700 | F+61 2 9212 2382 | E [email protected] | W www.ashm.org.au

11

Please use the form below to demonstrate your commitment to participate in advanced management for chronic hepatitis B.

Criterion 1 Completion of an accredited training course or recognition of prior learning

Criterion 2Access to appropriate support from senior clinicians working in a designated inpatient HBV treatment Centre/Liver clinic in a public hospital or private gastroenterologist treating HBV

Criterion 3 Commitment to ongoing HBV specific medical education

Criterion 1

Have you successfully completed the Hepatitis B s100 Prescriber Course course endorsed by your state or territory health department and plan to complete the associated assessment?

Criterion 2What is/are the HBV treatment Centre/Liver clinic that you usually refer to?

Name the senior clinician/s working in the setting you have named above to whom you would refer a patient should they require specialist care?

Name: Name:

Email: Email:

Phone: Phone:

Yes No

Application Form for HBV Prescribin

page 2


12

Describe any contact you already have had with the specialist/s named above?

Are there any other senior clinicians working in a designated HBV treatment centre or liver clinic (not necessarily the nearest to your practice) who you anticipate turning to if you need particular support or mentorship?

Yes No

Name:

Email:

Phone:

My preferred hospital is (leave blank if no preference):

If yes, please describe the means of support:

No - I would like ASHM to link me with a mentor

Yes NoYes No Yes No

Application Form for HBV Prescribing

page 3

Do you have a practice nurse?Are a GP are you in sole practice?

Can you derive any support from co-workers and colleagues with HBV prescriber caseloads?

Are you happy to allow ASHM to contact ALL of the aforementioned people to assist in setting up a specialist/GP relationship?

Yes No

ASHM publishes practice information for HBV prescribers via a directory on its website.

Please check here if you would prefer NOT to be listed in this directory once accredited.

Signed: Date:


13

FOR ATTENTION OF: <<insert specialist name here>>

Community prescriber name:

Patient initials and YOB:

Date:

Patient initiated on treatment number (x/5):

Reason for treatment initiation (summary)

Year CHB Diagnosed: Transmission risk:

Medical history:

Allergies: Current medications:

Hepatitis B Community s100 Prescriber Program

Pro Forma for initiation of first 5 patients on treatment

Initiation of patient on treatment

Pro forma for approval by linking specialist


14

Please tick relevant condition/risk factors (as appropriate)

Clinical exam:

Height (m): Weight (kg): BMI (kg/m2):

Sign of chronic liver disease (please tick where appropriate):

Evidence of decompensated liver disease (please tick where appropriate): one or more of the clinical complications of chronic liver disease

High risk of progression (please tick where appropriate):

Type 2 Diabetes; Year of dx:

Smoking; pack year:

Overweight / Obese

Family history of hepatocellular carcinoma (HCC)

Other drug use including IV drug use

Dyslipidaemia

Alcohol; approx. amount per week:

Jaundice

Encephalopathy

Hepatomegaly

Ascites Peripheral oedema

Splenomegaly

Spider naevi

Peripheral oedema

Variceal bleeding

Ascites

Encephalopathy Low albumin

Jaundice

High INR

Male

Presence of cirrhosis Heavy alcohol intake (>40-50g daily)

Age >45yrs

Family history of HCC Co-infection with HIV

Long duration of infection

Co-infection with HCV


Assessment

page 2

Co-infection with HDV


15

Tests

HBV DNA* and LFTs are recommended to be performed on a 12 monthly basis (at minimum) in all people with CHB not on treatment.

HBV Serology Liver enzymes/FBC

Test Date Result Test Date Result

HBV DNA* (IU/mL) ALT (U/L)

HBsAg AST (U/L)

HBeAg Albumin (g/L)

Anti-HBe Bilirubin (umol/L)

INR

PT (secs)

Hb (g/L)

WCC (x 10^9/L)

Platelets (x 10^9/L)

Creatinine (mL/min)

FibroScan (kPa)**

* HBV DNA is only funded once a year if patient is not on antiviral therapy.**A fibrosis assessment is recommended but not required under the PBS - Fibroscan where available, or APRI (AST to Platelet Ratio Index) where not. For further information see: http://www.hepatitisc.uw.edu/page/clinical-calculators/apri

FIBROSCAN INTERPRETATION

Correlation between liver stiffness (kPa) and fibrosis stage (Confounders include ALT/AST levels > 100 U/L and obesity)

• Best validated in HCV, HBV, obesity• Not validated in cholestasis or other diseases

Sequential readings 2nd yearly thought to be of benefit

Guidelines for HCV, HBV or Obesity

<5 No/minimal fibrosis

5-6 Low probability of significant fibrosis

>6-9 Difficult to interpret

>9-12 Significant fibrosis

>12 Possible cirrhosis


page 3

www.hepatitisc.uw.edu/page/clinical-calculators/apri


16

Phase of chronic hepatitis B infection

Phase HBV DNA(IU/mL) HBeAg HBeAb ALT Management My patient’s status

(please tick)

HBeAg +ve CHB

ImmuneTolerant >20 000 + - Often normal Monitor

ImmuneClearance

>20 000 (fluctuating) - -/+ Variable/raised Consider

treatment

HbeAg -ve CHB

ImmuneControl <2000 - + Normal Monitor

Co-infection immunity Once only testing required unless high risk

Test Date Result/comment

Anti-HCV

Anti-HAV IgG Immunisation is recommended if anti-HAV IgG not detected

Anti-HDV

HIV

HCC/Cirrhosis Surveillance

Test Date Result/comment Surveillance interval

Ultrasound

Discussion with the patient included:

Natural history of HBV

Importance of regular monitoring Testing and vaccination of household/family contacts

Provided written information and resource list

Transmission and prevention

Treatment options The importance of adherence

Self-management advice

Treatment may be lifelong

Treatment choice and monitoring

I plan to start treatment with (please tick):

Entecavir Tenofovir

Pegylated interferon could also be considered as an option, particularly in younger people with ALT >5 x ULN who are HBeAg positive. If you think PEG-IFN is an option for this person, please discuss this with your specialist mentor before filling out the form any further.

I plan to monitor treatment with:


page 4


17

Declaration

I declare all of the information provided above is true and correct

Name:

Signature:

Date:

Specialist approval

I agree with the decision to initiate treatment based on the information provided above

Name:

Signature:

Date:

Examples of when to seek urgent advice / referral:

• Cirrhosis (especially where suggestion of decompensation);• Possible HCC found on surveillance;• Woman who is pregnant or planning pregnancy.• Patient requires immunosuppressive treatment or chemotherapy

These situations need immediate discussion and triage prioritisation with specialist service.


page 5


Appendix 3.2: Pro Forma Guidelines

Pro Forma Guidelines for Hepatitis B s100 Community Prescribers

Why do I need to complete the pro forma?Hepatitis B treatment, for the majority of patients, will be life-long; therefore the decision to initiate a patient onto treatment is of great importance. To support GPs new to initiating treatment for hepatitis B, linking specialists will review the initiation work-up for the first five patients, to confirm that the decision to start treatment is appropriate at that time.

When does the pro forma need to be completed?For the first five patients you intend to start on treatment, the pro forma will need to be completed in full and sent to the specialist for review. GPs should allow adequate time for this review to be completed prior to the appointment when you intend to write the first script initiating your patient onto treatment.

How do I complete the pro forma?Once you have all of the relevant information and have completed the pro forma in full you need to send the document to your linking specialist via their preferred method as described to you in the email from ASHM on X date.

If sending the pro forma by email please ensure you cc ASHM using the following email address [email protected]

What should I do if don’t hear back from the specialist?If you don’t hear back from your linking specialist within the time frame specified you may follow up with them using the method as described to you in the email from ASHM on X date.

If you have not heard back from your linking specialist within a week of sending the pro forma please contact ASHM for

further advice.

What should I do if the linking specialist disagrees with my decision to start the patient on treatment?If, having reviewed the pro forma, your linking specialist does not agree with your decision to start the patient on treatment and you do not understand the reasoning behind it, either discuss this with your specialist in more detail or contact ASHM for further advice.

mailto:HBVprescriber%40ashm.org.au%20?subject=HBV%20Prescriber%201


19

Name of applicant:

Contact details: Address:

Phone:

Email:

Name of activity:

Name of organising CPD/CME provider:

Duration/times: (Educational activity time only, not including refreshment/meal breaks)

Date(s):

1. Briefly describe the type of activity OR attach the program with your application. What were your learning objectives for this activity and to what extent were they met?

2. What interactive activities did you participate in during the activity (case study presentation, facilitation of a discussion group, Q&A etc.)?

HBV CPD self-adjudication form

Application by an HBV s100 Prescriber for HBV CPD Adjudication of an Educational Activity

Note: This application may be submitted vie email, fax or post, and must be accompanied by supporting documentation, as outlined in the CPD activity table in the prescriber handbook


20

3. In what way will the content of this activity meet your professional development needs and help you to improve outcomes for your patients living with chronic hepatitis B? Will you change your clinical practice as a result of this activity?

Please attach a certificate or any other confirmation (email etc) of your attendance.

Name:

Signature:

Date:

HBV CPD self-adjudication form

page 2


Appendix 5: HBV CPD activities delivered by external providers

Organisations wishing to have their educational activities adjudicated may apply to the ASHM secretariat staff at any time. The activities of external CPD providers can be awarded HBV CPD points only if the provider has completed an application for HBV CPD adjudication.The application by the external CPD provider should be made prospectively. The form is available from and processed by ASHM secretariat staff.

If an external CPD provider has not applied for HBV CPD points for an activity, a primary care practitioner who has attended or completed that activity may apply for HBV CPD adjudication retrospectively. Primary care practitioners are also encouraged to apply for adjudication of HBV CPD activities within their own practice, for example clinical audit or case discussion activities. Most applications for HBV CPD points will be adjudicated by ASHM clinical advisors working with the HBV advanced education program. Any contentious applications will be forwarded to the HBV Clinical Standards and Accreditation Panel for adjudication.

HBV CPD points are allocated to each activity that is adjudicated as per the guide above. One-off events such as conferences, seminars and workshops will be awarded points on the basis of an assessment of the extent to which the activity educates, informs and develops primary care practitioners in relation to the management of HBV infection and treatment with highly specialised drugs. External HBV CPD providers must submit attendance sheets to ASHM in order for the HBV CPD points for primary care practitioners attending that activity to be recorded.

The HBV CPD adjudication application form requests that external providers describe the activity and provide details on how it will meet the needs of primary care practitioners involved in HBV collaborative care. The provider must state the learning objectives for the activity and attach the program for the activity with details on the speaker(s), together with the PowerPoint presentation(s). CPD providers failing to provide adequate information will be advised to resubmit their application.


22

Please complete the form below and send it to [email protected]

Name of organisation

Contact name

Contact details Address:

Phone:

Email:

Name of activity

Name of venue, address and state

Duration of educational component (Please exclude break times)

Date(s)

Provider Adjudication Form

Application Adjudication of Educational Activity by an Organisation (CPD provider)

Note: The following terms and conditions regarding submission of a HBV CPD (Continuing Professional Development) adjudication application:

• All applications and supporting documentation must be submitted electronically;

• Providers are required to supply details of the entire program and all available training materials;

• PowerPoint presentations must be submitted with the initial application from a CPD provider that has not previously had an application processed. CPD providers who have previously submitted successful applications do not have to submit PowerPoint presentations if they are not available from the speaker(s) if details on the content of the presentation(s) are provided in the application.

• Direct marketing of an industry drug is not acceptable and is prohibited at an event being considered for HBV CPD accreditation. The inclusion of direct marketing will result in HBV CPD accreditation being withdrawn;

• Attendance lists will only be accepted in the electronic format provided and must be submitted to ASHM within two weeks of the event;

• The ASHM logo is not to be used on any publicity or displayed at an event;

• HBV CPD logos will be sent to CPD providers for inclusion on publicity materials.

• If you require any advice regarding the completion of this form, please contact the HBV s100 Prescriber Project Officer on 02 8204 0769 or email [email protected]

mailto:education%40ashm.org.au?subject=



23


1. Briefly describe the activity & attach the program with details of the agenda, speakers, topics etc. to your application.

2. In what way will the content of this activity meet the professional development needs of HBV s100 prescribers and improve outcomes for their patients?

3. What are the learning objectives for the activity? (These must relate directly to the content of the CPD activity)

4. Are there interactive components to the activity such as, case presentation and discussion?

page 2


24


Submitted by:

Date:

5. Please outline the involvement of HBV s100 prescribers in: (i) planning of the activity; and (ii) delivering the activity (e.g. teaching/presenting).

6. How do you propose to evaluate the activity?

7. Have any professional colleges adjudicated the activity for continuing professional development (CPD), Maintenance of Professional Standards Program (MOPS) or continuing medical education (CME), and if so what was the outcome of that adjudication and the point allocation?

8. Other comments or information to accompany your application

page 3


25

Event Title:

Venue (address & state):

CPD points awarded:

Date:

Provider and contact name:

Name Practice Suburb

Attendance Form

HBV s100 Prescriber Continuing Professional Development ProgramAttendance list to be submitted by CPD provider after event

Note: Attendance lists will only be accepted in this electronic format.

Submission of this completed form to ASHM ([email protected]) within two weeks is mandatory for all events awarded HBV CPD points.


Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)

Published by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)46 Kippax Street, Surry Hills NSW 2010 | +61 2 8204 0700

www.ashm.org.au

© Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), 2014