Approximately 75% of patients with hepatitis C virus (HCV) are born in the years 1945 to 1965. The CDC recommends a one-time screen for patients within that age range, regardless of risk factors. The societal and economic burden of HCV is expected to grow significantly over the next decades. An increase in appropriate screening will lead to diagnosis and treatment of previously unrecognized HCV and can serve to reduce the burden of disease through decreased sequelae including cirrhosis and hepatocellular carcinoma. Implementing screening for HCV in primary care may be challenging so effective mechanisms are needed.
Three individual based interventions were initiated targeting patients born from 1945-1965 in a community based teaching clinic over a year period. Individual interventions included resident lectures, public education posters placed in the clinic, and a reminder flier placed into patient charts. Ultimately, a systems based intervention was initiated with an electronic HCV screening reminder tab added to age appropriate patients, not previously screened. The rates of screening were compared to rates when no intervention was performed. The percent of patients who were tested for each time-period was calculated, along with their corresponding 95% confidence intervals. The chi-square test was used to compare the percent of patients who were tested among the three time-periods. SAS version 9.4, was used for all analysis. A two-tailed p-value of less than 0.05 was considered statistically significant.
Over the study period 14,676 patients met criteria for birth cohort screening. The results of screening are shown in the Table. For the non-intervention time period, 29.6% (2394/8097) of the patients seen over a period of 6 months had been screened for HCV. For the individual based intervention time period, 23.5% (789/3362) of the patients were screened. For the systems based intervention with the initiation of health maintenance tab, 60.3% (1941/3217) of patients were screened. The p-value was <0.001 for systems based intervention compared to non-intervention period and the individual intervention period.
Systems based interventions are the most effective intervention to improve HCV screening for individuals born from 1945-1965 compared to individual based interventions.
To cite this abstract:Spence, LH; Beasley, S; Simmelink, A; Furney, S; Russo, M; Norton, J . IMPROVING HEPATITIS C SCREENING IN A RESIDENT BASED CLINIC: RESULTS OF INDIVIDUAL VERSUS SYSTEMS BASED INTERVENTIONS. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 219. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/improving-hepatitis-c-screening-in-a-resident-based-clinic-results-of-individual-versus-systems-based-interventions/. Accessed May 24, 2019.