提升C型肝炎病人接受全口服抗病毒藥物治療正確時間回診檢驗率專案

Improving Right-time Laboratory Test Rate for Patients with Chronic Hepatitis C Undergoing Direct-acting Antiviral Treatment

慢性C型肝炎為世界重要的公共衛生議題之一，臨床治療目標為清除病毒，臺灣於2017年1月24日正式將C型肝炎全口服抗病毒藥物（direct-acting antiviral, DAA，以下簡稱DAA）有條件的納入健保給付，新型全口服抗病毒藥物只需服用3至6個月，治癒率可達90％以上，成效相對顯著。病人接受治療期間，醫事服務機構必須依時序登錄個案後續追蹤之病毒量（療程結束時及療程結束後第12週）及相關檢驗結果（使用後第4週、療程結束時及療程結束後第12週）。因此，病人於治療期間的正確時間回診檢驗率是個案管理師的重要職責。本院門診於2017年1月施行「DAA新藥執行計畫」，實施半年，於2017年6月26日調查療程結束後第12週正確時間回診檢驗率為73.3％，偏低！經現況分析發現病人未能配合於正確時間回診檢驗，主因為提前或延後時間檢驗，導致影響治療效果之判定、健保資料庫之登錄、健保相關給付及耗費醫療資源。故自2017年6月至2018年8月進行專案改善，為期一年，旨在提升DAA門診病人正確時間回診檢驗率。擬定改善措施包含：專科課程安排DAA課程、個別回診卡製作、設立門診DAA開立組套、醫師看診提醒單、肝炎個管師每日稽核名單及設立諮詢專線。藉由本專案的改善計畫，本院門診施行「DAA新藥執行計畫」後，病人正確時間回診檢驗率提升至99％，有效提升DAA門診病人於正確時間完成回診檢驗並提升照護品質。

Chronic hepatitis C is a major public health concerns worldwide. The primary goal of hepatitis C virus therapy is to cure the infection to achieve a sustained virological response, defined as undetectable HCV–RNA 12 weeks after treatment completion (SVR12). The National Health Insurance Administration of Taiwan began to reimburse certain direct-acting antiviral (DAA) treatment in January 2017. We found a right-time laboratory test rate of SVR12 of 73.3%, which was low. Employing a status quo analysis, we concluded that the barrier of a low right-time laboratory test rate may affect treatment outcomes. Conducted from June 2017 to August 2018, our project aimed to increase the right-time laboratory test rate. The following measures were implemented: professional education, individual DAA treatment follow-up cards, DAA treatment in an outpatient department system, treatment reminder lists for doctors, monitoring of daily cases by a hepatitis case manager, and consultation phone lines. These measures increased the right-time laboratory test rate to 99%. As a result, the quality of care for patients with hepatitis C undergoing DAAs treatment also improved.