From the 2018 HVPAA National Conference
Since recommendations from CDC and USPSTF in 2012, several institutions including ours have implemented “electronic health alert” that prompted health care providers to screen for hepatitis C virus infection among baby boomers. This has improved the screening rate by five-fold in other institutions, but the rate remains low in ours.
To assess and improve the hepatitis C screening rate among baby boomers.
We studied patients who were either admitted or seen as outpatients in our hospital between September 2017 and January 2018. Pre-intervention phase includes 244 outpatients and 760 inpatients. Intervention phase includes 89 outpatients and 96 inpatients. Primary endpoint is hepatitis C virus antibody test. Patients who were diagnosed metastatic malignancy, critically ill, previously screened, and non-primary patients were excluded from the study. Interventions include targeted education by posting educational pamphlets in patient’s rooms, physicians working areas, and sending reminder emails.
In our outpatient clinic, the screening rate improved from 22.5% to 46% after our intervention. Two patients received positive antibody tests, but the viral loads were negative. Seven patients did not complete the test although it was ordered. In the inpatient setting, it improved from 22.9% to 50%. Among four patients who were tested positive, two patients were referred to gastroenterology clinic, one passed away from other illness, and the other one was neither referred nor tested for viral RNA.
Our study shows that “electronic health alert” alone cannot guarantee compliance with the recommendations. Targeted education to both physicians and patients is necessary and effective in improving the screening rates, but the continuous efforts from both parties are required.
Implications for the Patient
Our study encourages practicing physician to order hepatitis C virus antibodies to all baby boomers who are eligible in order to achieve maximum benefits from the screening.