肝炎医療コーディネーター導入による肝炎ウイルス陽性者対応の適正化

Effect of the introduction of hepatitis medical coordinators to respond hepatitis virus-positive patients

要約　目的：医療機関での術前検査時に肝炎ウイルス陽性が発見されることがある。筆者らは眼科病棟に肝炎医療コーディネーター（肝Co）を養成し，ウイルス肝炎検査の陽性者対応の適正化を試みた。

対象と方法：肝Co設置前後の33か月間に術前検査としてHBs抗原とHCV抗体検査を行い，いずれかが陽性であった96名を対象とした。診療録をもとにウイルス肝炎の治療歴，HCV抗体価，陽性者対応の有無，眼疾患の種類を調べた。

結果：HBs抗原陽性が新規に発見された4例のうち，肝Co配置前の1例は未対応であった。HCV抗体陽性の新規発見は37例あった。肝Co配置前の新規発見は22例あり，うち16例が未対応であった。B型とC型を合わせた未対応17例のうち9例は検査結果を待たずに緊急手術を行っていた。肝Co配置後の未対応はなかった。

結論：肝Coの導入は肝炎ウイルス検査の結果説明と陽性者対応の適正化に有効であった。

Abstract　Purpose：During preoperative laboratory examination at medical institutions, patients are sometimes found to be hepatitis virus-positive. A hepatitis medical care coordinator was trained in the ophthalmology ward to optimize the care of patients who test positive for viral hepatitis.

Subjects and methods：Hepatitis B surface（HBs）antigen and hepatitis C virus（HCV）antibody tests were performed as preoperative tests for 33 months before and after the introduction of the hepatitis medical care coordinator, and the 96 patients whose results were positive on either of these tests were included as the subjects. History of treatment for viral hepatitis, HCV antibody level, whether those who tested positive received any treatment, and the kind of ophthalmological disease were investigated from the medical records.

Results：Of the four patients newly discovered to be positive for HBs antigen, no treatment was provided to one patient prior to the introduction of the coordinator. The number of patients newly discovered to be positive for HCV antibody was 37. Twenty-two patients were newly discovered prior to the introduction of the hepatitis medical care coordinator, and no treatment was provided to 16. Of the 17 combined untreated patients with type B and type C hepatitis, emergency surgery was performed without waiting for test results in 9. After the introduction of the hepatitis medical care coordinator, there were no cases in which no treatment was provided.

Conclusion：The introduction of a hepatitis medical care coordinator was effective in optimizing the explanation of hepatitis virus test results and the care of patients who tested positive.