title: Challenges to the effective delivery of health care to people with chronic hepatitis B in Australia.
abstract: BACKGROUND
  The complexity of the hepatitis B natural history and its prevalence in specific populations in Australia challenges the capacity of the health system to deliver health care effectively to affected people. This study explores the challenges in delivering health care to people with chronic hepatitis B (CHB) in Australia.
  
  
  METHODS
  We conducted a grounded theory based qualitative study in which data were gathered from 70 in-depth interviews with government program officers, clinicians and health and community workers across Australia, and four focus group discussions with 40 health and community workers from the communities most at risk of CHB.
  
  
  RESULTS
  A systematic approach to screening populations at risk, including people born in countries with intermediate or high prevalence of CHB; consensus on clinical guidelines; development of a shared care framework for CHB involving general practitioners; and effective communication between patients and health professionals were identified as essential. Workforce development, particularly for primary health care professionals, and developing the knowledge and capacity of health professionals to communicate effectively with people with HBV were described as other major factors in reducing the barriers to CHB treatment in Australia.
  
  
  CONCLUSIONS
  To improve the clinical management of people with CHB in Australia, the health system needs to encourage the screening of people at risk, improve access to clinical services, and the knowledge and communication skills of primary health care and community health service providers. This study supported developing a shared care model and related infrastructures including training programs, referral pathways and clinical guidelines.
authors.affiliation: Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia. j.wallace@latrobe.edu.au
authors.forename: Jack
authors.initials: J
authors.lastname: Wallace
authors.forename: Stephen
authors.initials: S
authors.lastname: McNally
authors.forename: Jacqui
authors.initials: J
authors.lastname: Richmond
authors.forename: Behzad
authors.initials: B
authors.lastname: Hajarizadeh
authors.forename: Marian
authors.initials: M
authors.lastname: Pitts
mesh_terms: D001315:Australia / Q000453:epidemiology; D003151:Community Health Centers / Q000458:organization & administration; D003153:Community Health Services / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D017144:Focus Groups; D006266:Health Education / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data