Electronic health record year and country of birth testing and patient navigation to increase diagnosis of chronic viral hepatitis

Abstract

The United States Preventive Services Task Force recommends hepatitis C testing people born from 1945 to 1965, “birth cohort” as well as hepatitis C and hepatitis B testing people from countries of birth with endemic infection risk. We automated the hospital electronic health record system to test birth cohort and those born in countries with endemic infection risk. A script is launched searching the laboratory database upon registration for any hepatitis C antibody, hepatitis C RNA and/or hepatitis B surface antigen result. If no positive result was found, a hepatitis C antibody/reflex RNA and/or hepatitis B surface antigen were ordered. A patient navigator received weekly results and assisted patients with positive serology to schedule an appointment with their primary care provider or treatment specialist. A total of 10 726 participants were hepatitis C antibody tested, with 6.9% antibody positive. Monthly hepatitis C testing from January to July 2016 compared to August 2016‐August 2017 increased 342% as a result of "birth cohort" testing. Following country of birth testing, monthly hepatitis B and hepatitis C testing increased 91%, and 44%, respectively, during June‐August 2017 compared to September 2017‐March 2018. 67% of hepatitis C‐positive patients were linked to care. If the navigator contacted the patient, 92% were linked to care, and 32% were treated. Of hepatitis B surface antigen‐positive patients, 43% were linked to care, 5% were on treatment, and 15% started treatment. Automated electronic health record ordering of hepatitis C and/or hepatitis B testing is feasible and increases testing. In the population tested, much improvement is needed with linkage to care and treatment.

Integrating Management of Hepatitis C Infection into Primary Care: the Key to Hepatitis C Elimination Efforts

“…If resources allow, patient navigators increase patient linkage to care after initial diagnosis of chronic hepatitis C and partnering with specialty pharmacies is another means to streamline medication authorization and to provide patients support during treatment (Table 2). [107][108][109][110][111] Thus, primary care practices need to consider the best options for patient support during their journey from HCV diagnosis to cure, with the recognition that resources may be limited.…”