Impact of electronic reminder systems on hepatitis C screening in primary care

Abstract

Screening for hepatitis C virus (HCV) was recommended in 2012 by the Centers for Disease Control (CDC) for the population born between 1946 and 1965. Reminder systems are effective at promoting HCV screening, but the yield of positive tests among various population subgroups and the linkage to specialty HCV treatment is not well understood. We sought to determine: (i) the effect of the CDC recommendation alone, and the effect of an electronic medical record (EMR) reminder on the proportion of the population screened; (ii) the yield of positive HCV tests as screening strategies have evolved, and according to a patient's history of serum aminotransferase testing; (iii) the proportion of positive cases followed up for HCV treatment. This retrospective cohort study included 60 000 primary care patients at a northeast US academic medical centre serving an urban and rural population in which an EMR reminder was instituted in 2014. Results demonstrated an increase in proportion tested for HCV from 12% prior to the CDC recommendation to 37% after the reminder system. The yield of positive HCV antibody (HCV Ab) tests decreased from 7% in the "case-finding" era to 1.6% after the EMR reminder prompted screening of a lower risk population (P < .001). Patients with a history of abnormal aminotransferase tests had a fivefold higher rate of positive HCV Ab testing (6.7% vs 1.5%, P < .001). Ninety per cent of patients with confirmed HCV infection were seen in specialty care.

Evaluation of a Multifaceted Intervention to Reduce Health Disparities in Hepatitis C Screening: A Pre‐Post Analysis

“…However, the proportion of HCV infection was still high in the postintervention group, indicating the disproportionately higher burden of disease in our safety‐net hospital compared to the estimated prevalence of 1% in the United States . Others have also reported a drop in the proportion of HCV‐infected after implementation of universal HCV screening …”

“…Although studies have suggested a benefit to EMR‐based BPAs, increases in screening uptake fall short of desired goals, highlighting the need for multifaceted interventions such as the one we have implemented . Prior studies in other diseases have similarly demonstrated a benefit to multifaceted interventions compared to single‐component interventions, such as an EMR alert .…”

“…BPAs for baby boomer screening have been shown to increase screening rates in trials and implementation studies . Others have coupled BPAs with care coordination or patient navigation to increase screening rates. Our study, like others, uses an EMR‐based BPA, provider and patient education, and provider detailing in a multifaceted intervention to increase HCV screening rates.…”

Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

“…Previous studies have shown that electronic health record embedded alerts markedly increased HCV testing among patients born between 1945 and 1965 23 27 36–39. In this quality improvement project, we implemented multiple changes in the electronic health record nursing workflow.…”

Prescribing direct‐acting antivirals to treat hepatitis C virus in a general practice setting in Australia: ‘so why not do it’?

“…Developing systems and protocols for routine HCV screening in general practice settings is essential and can increase GP uptake of HCV treatment . Establishing electronic reminder systems and promoting the use of current general practice software for both screening and management of HCV diagnosis and treatment is required . Only two GP‐participants in this study reported using such systems and both indicated its usefulness for identifying new HCV patients and streamlining follow‐up processes.…”