Hepatitis C virus infection in the 1945-1965 birth cohort (baby boomers) in a large urban ED

Allison, Waridibo E.; Chiang, William K.; Rubin, Ada; O’Donnell, Lauren; Saldivar, Miguel A.; Maurantonio, Michael; Cruz, Jeffrey Dela; Duvidovich, Svetlana; Carmody, Ellie

doi:10.1016/j.ajem.2015.12.072

Cited by 30 publications

(31 citation statements)

References 18 publications

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“…The reported ranges for screening among this cohort vary but in general are estimated to be <30%, even after implementing interventions specifically aimed at increasing HCV screening among baby boomers . Various approaches have been evaluated to optimize screening rates including integration of HCV screening into other preventive health screening like colonoscopy or human immunodeficiency virus testing, as well as screening in emergency room and inpatient settings . In order for HCV screening to have the highest impact, however, screening needs to be linked with subsequent care after test results are available.…”

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confidence: 99%

“…(9)(10)(11)(12) Various approaches have been evaluated to optimize screening rates including integration of HCV screening into other preventive health screening like colonoscopy or human immunodeficiency virus testing, as well as screening in emergency room and inpatient settings. (13)(14)(15)(16) In order for HCV screening to have the highest impact, however, screening needs to be linked with subsequent care after test results are available. Prior estimates from outpatient and emergency room settings have shown that 30%-50% of persons who test positive for HCV antibody (anti-HCV) never receive confirmatory HCV RNA testing, and among those with a confirmed diagnosis of HCV infection, only a minority (approximately 35%) are connected with specialty care.…”

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confidence: 99%

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Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Konerman¹,

Thomson²,

Gray³

et al. 2017

Hepatology

103

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Despite effective treatment for chronic hepatitis C (CHC), deficiencies in diagnosis and access preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record (EHR) based prompt on HCV screening rates in baby boomers in primary care, and access to specialty care and treatment among those newly diagnosed. We implemented an EHR based “Best Practice Advisory” (BPA) that prompted primary care providers (PCPs) to perform HCV screening for patients seen in primary care clinic: 1) born between 1945–1965; 2) lacked a prior diagnosis of HCV infection; and 3) lacked prior documented anti-HCV testing. The BPA had associated educational materials, order set, and streamlined access to specialty care for newly diagnosed patients. Pre and post BPA screening rates were compared and care of newly diagnosed patients analyzed. In the 3 years prior to BPA implementation, 52,660 baby boomers were seen in primary care clinics, and 28% were screened. HCV screening increased from 7.6% for patients with a PCP visit in the 6 months prior to BPA to 72% over the 1-year post BPA. Of 53 newly diagnosed patients, all were referred for specialty care, 11 had advanced fibrosis or cirrhosis, 20 started treatment and 9 achieved SVR thus far. Conclusions Implementation of an EHR based prompt increased HCV screening rates among baby boomers in primary care by 5 fold due to efficiency in determining needs for HCV screening and work-flow design. Streamlined access to specialty care enabled patients with previously undiagnosed advanced disease to be cured. This intervention can be easily integrated into EHR systems to increase HCV diagnosis and linkage to care.

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confidence: 99%

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confidence: 99%

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Konerman¹,

Thomson²,

Gray³

et al. 2017

Hepatology

103

View full text Add to dashboard Cite

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“…Only 55.6% of people with chronic HCV infection are aware of their infection . African American baby boomers and urban emergency departments have prevalence rates as high as 14% . The opioid epidemic has driven a recent surge in acute cases of HCV, primarily in younger populations .…”

Section: Introductionmentioning

confidence: 99%

Defining the hepatitis C cure cascade in an Urban health system using the electronic health record

Miller

Millman

Lom

et al. 2019

Journal of Viral Hepatitis

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Hepatitis C virus (HCV) infection is a public health threat. The electronic health record (EHR) can be used to monitor patients along the HCV cure cascade and highlight opportunities for interventions to improve cascade outcomes. We developed an HCV patient registry using data from Grady Health System's (GHS) EHR and performed a cross‐sectional analysis of 72 745 GHS patients who received anti‐HCV testing from 2004 to 2016. We created a testing cascade: (1) anti‐HCV reactive, (2) HCV RNA tested and (3) HCV RNA detectable; and a cure cascade: (1) HCV RNA detectable, (2) engaged in care, (3) treatment prescribed, (4) sustained virologic response (SVR) tested and (5) SVR documented. A total of 9893 (14%) had reactive anti‐HCV tests of 72 745 patients tested, 5109 (52%) of these had HCV RNA tested, and 4224 (43%) were HCV RNA detectable. A total of 2738 (65%) of 4224 with detectable RNA were engaged in care, 909 (22%) were prescribed antiviral therapy, and 354 (8%) achieved SVR. Factors associated with HCV treatment included cirrhosis, tobacco use, depression, diabetes, obesity, alcohol use, male gender, black race and Medicare insurance. Uninsured patients were significantly less likely to be prescribed HCV treatment. In conclusion, using EHR data, we identified high anti‐HCV prevalence and noted gaps in HCV RNA testing, linkage to care and treatment. The EHR can be used to evaluate the effectiveness of targeted interventions to overcome these gaps.

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“…In fact, studies evaluating HCV testing of adults born during 1945–1965 in urban emergency departments found HCV antibody positivity rates ranging from 7.3–14.7% primarily in socioeconomically disadvantaged populations. [47•, 48]. …”

Section: Special Populations and Disparitiesmentioning

confidence: 99%

Hepatitis C: Review of the Epidemiology, Clinical Care, and Continued Challenges in the Direct-Acting Antiviral Era

2017

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Purpose of Review This review highlights key studies and recently published data, policies, and recommendations related to hepatitis C virus (HCV) epidemiology, transmission, and treatment. Recent Findings HCV is a leading cause of liver-related deaths, cirrhosis, and hepatocellular carcinoma. Since 2011 and accelerating since 2013, new, safe, tolerable, and curative therapies have considerably altered clinical and public health frameworks related to the prevention, control and clinical management of HCV. Nevertheless, there are several populations in the United States that are important to consider because of disparities in HCV prevalence and transmission risk. Adults born during 1945–1965 have an estimated anti-HCV antibody prevalence of ~3%, which is six times higher than among other adults, are often unaware of their infections, and are at increased risk of having HCV-associated morbidity and mortality from decades of chronic infection. Since the early 2000s, increasing incidence of acute HCV infections among young, white, non-urban people who inject drugs have been reported. Despite promising therapeutic advances, significant challenges remain for reducing HCV-associated morbidity and mortality. Summary The high burden of HCV and significant health consequences associated with chronic infection make HCV a critical public health priority. Advances in HCV treatment have created new opportunities for reducing HCV-associated morbidity and mortality. These treatments are safe, well-tolerated, and highly effective; however, benefits cannot be realized without a significant increase in the number of persons tested for HCV so that all chronically infected individuals can be aware of their diagnosis and linked to appropriate clinical care.

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Hepatitis C virus infection in the 1945-1965 birth cohort (baby boomers) in a large urban ED

Cited by 30 publications

References 18 publications

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Impact of an electronic health record alert in primary care on increasing hepatitis c screening and curative treatment for baby boomers

Defining the hepatitis C cure cascade in an Urban health system using the electronic health record

Hepatitis C: Review of the Epidemiology, Clinical Care, and Continued Challenges in the Direct-Acting Antiviral Era

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