Management of chronic Hepatitis B infection in the remote primary health care setting: The search for a suitable guideline


Dr Virginia Cross, School of Medicine and Dentistry, James Cook University, 101 Angus Smith Drive, Townsville, Queensland, 4811, Australia. Email:


Objective: To identify a regionally appropriate guideline for the primary health care management of chronic Hepatitis B patients in the Torres Strait.

Design: Literature review. PubMed (1950–November 2009), Nursing and allied health (CINAHL)-CD (1982–November 2009), and the following databases accessed through INFORMIT: Australian Public Affairs Information Service – Health (1978–November 2009), Aboriginal and Torres Strait Health Bibliography (1900–November 2009), Health & Society Database (1980–November 2009), Health Collection (1980–November 2009), Meditext (1968–November 2009), and Rural and Remote Health Database (1966–January 2006) were searched over a 3-month period from September to November 2009. An Internet search of relevant guidelines and recommendations from professional bodies such as the World Health Organization was also performed.

Setting: Remote primary health care.

Outcome measures: Initial searching identified 144 articles to include based on the provision of recommendations or guidelines for management of Hepatitis B at the primary care level. Included articles were then reviewed for their appropriateness to the remote primary health care setting against a set of five criteria determined at a consensus meeting of eight local medical officers.

Results: Eleven articles were included for final review of which none met all five criteria of appropriateness for the remote primary health care setting.

Conclusions: Guidelines need to recognize the difficulties of rural and remote practice and present practical alternatives to urban centred recommendations.