Virtual monitoring for stable chronic hepatitis B patients does not reduce adherence to medications: A randomised controlled study

Chronic hepatitis B (CHB) remains common in endemic regions, causing significant healthcare burden. Patients with CHB may need to be adherent to nucleoside analogue (NA) for a long period of time to prevent complications. This study aims to investigate the safety, efficacy and patient experience of...

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Bibliographic Details
Published in:	Journal of telemedicine and telecare Vol. 29; no. 4; p. 261
Main Authors:	Kumar, Rajneesh, Yee, Mei-Ling, Goh, George Bb, Chia, Pei-Yuh, Lee, Hwei-Ling, Xin, X, Teo, Pek Se, Ekstrom, Victoria Sm, Tan, Jin Yt, Cheah, Mark Cc, Wang, Yu T, Chang, Jason Pe, Tan, Chee-Keat, Tan, Hiang Keat, Krishnamoorthy, Thinesh L, Chow, Wan-Cheng
Format:	Journal Article
Language:	English
Published:	England 01-05-2023
Subjects:	Aged Antiviral Agents - therapeutic use Carcinoma, Hepatocellular - drug therapy Carcinoma, Hepatocellular - epidemiology Carcinoma, Hepatocellular - etiology Female Hepatitis B, Chronic - complications Hepatitis B, Chronic - drug therapy Hepatitis B, Chronic - epidemiology Humans Incidence Liver Neoplasms - drug therapy Liver Neoplasms - epidemiology Liver Neoplasms - etiology Male Middle Aged randomised controlled trial Chronic hepatitis B adherence to medications stable telehealth virtual monitoring
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Summary:	Chronic hepatitis B (CHB) remains common in endemic regions, causing significant healthcare burden. Patients with CHB may need to be adherent to nucleoside analogue (NA) for a long period of time to prevent complications. This study aims to investigate the safety, efficacy and patient experience of a virtual monitoring clinic (VMC) in monitoring stable patients taking NA for CHB. Patients on NA and regular follow-up were randomised to either VMC alternating with doctors' clinic visit or to a control group in which they continued standard follow-up by doctors. Therapy adherence was measured by medication possession ratio (MPR) for NA therapy, incidence of virological breakthrough and hepatocellular carcinoma (HCC) development at two years of follow-up. Patient acceptance was measured on a Likert scale of 1-10. A total 192 patients completed follow-up: 94 and 98 patients in the VMC and control groups, respectively. Mean age was 60.6 ± 10.8 years, with 95.3% Chinese ethnicity and 64.1% males. Age, gender, race, educational, employment and financial status were similar in both groups. Upon study completion, the majority of patients - 76 (80.9%) in VMC group and 74 (75.5%) in control group - had MPR ≥0.8; 88.8% were satisfied and rated VMC better than a traditional follow-up clinic with doctors only. More than 85% of patients rated ≥8/10 on the Likert scale for VMC, and preferred VMC over traditional clinic visits. Clinical outcomes observed were HCC development in one (1.1%) in the VMC group and four (4.1%) in the control group ( = 0.369). Two (2.1%) and one (1.0%) virological breakthroughs were observed in the VMC and control groups, respectively ( = 0.615). No incidence of HCC or abnormal blood tests were missed in the VMC arm. VMC is a viable and safe clinical model for monitoring stable CHB patients on NA therapy without compromising patients' adherence to medications and is preferred by patients.
ISSN:	1758-1109
DOI:	10.1177/1357633X20980298