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Research ArticleOriginal Research

Primary Care Evaluation of a Hepatitis C Virus (HCV) Screening Education Intervention

Thomas Ludden, Lindsay Shade, Jeremy Thomas, Mark W. Russo, Michael Leonard, Philippe J. Zamor, Charity G. Patterson and Hazel Tapp
The Journal of the American Board of Family Medicine October 2022, 35 (5) 990-997; DOI: https://doi.org/10.3122/jabfm.2022.05.210508
Thomas Ludden
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
PhD
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Lindsay Shade
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
PA-C
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Jeremy Thomas
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
MSW
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Mark W. Russo
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
MD
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Michael Leonard
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
MD
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Philippe J. Zamor
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
MD
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Charity G. Patterson
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Hazel Tapp
From Department of Family Medicine, Atrium Health, Charlotte, NC (TL, LS, JT, HT); Department of Hepatology, Atrium Health, Charlotte, NC (MWR, PJZ); Department of Infectious Diseases, Atrium Health, Charlotte, NC (ML); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CGP).
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Article Figures & Data

Figures

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    Figure 1.

    Study design for 15 practices into 3 wedges.

  • Figure 2.
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    Figure 2.

    Incidence rate of patients screened for Hepatitis C virus (HCV) for each time period without any previous record of HCV screening. Each wedge consists of 5 practices and each time period consist of 3 months.

Tables

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    Table 1.

    Stepped Wedge Study Design and Number of Patients Eligible for Hepatitis C virus (HCV) Screening

    Time Period 1 Baseline (0–3 months)Time Period 2(3–6 months)Time Period 3(6–9 months)Time Period 4(9–12 months)
    Practice 1 to 5 (Wedge 1)6,2066,2966,1846,020
    Practice 6 to 10 (Wedge 2)11,09211,73811,46010,727
    Practice 11 to 15 (Wedge 3)4,2443,9624,0873,681
    • Control periods before the HCV education intervention (non-underlined); intervention periods after the rollout of the HCV educational intervention (underlined).

    • View popup
    Table 2.

    Descriptive Statistics: Patient Population

    ControlIntervention
    n = 41,3291n = 44,3681p-value
    Wedge<0.001
     16,206 (15%)18,500 (42%)
     222,830 (55%)22,187 (50%)
     312,293 (30%)3,681 (8.3%)
    Time Period<0.001
     121,542 (52%)0 (0%)
     215,700 (38%)6,296 (14%)
     34,087 (9.9%)17,644 (40%)
     40 (0%)20,428 (46%)
    White29,526 (71%)33,048 (74%)<0.001
    African American9,507 (23%)8,885 (20%)<0.001
    Asian704 (1.7%)807 (1.8%)0.2
    Multi-Race/Other1,592 (3.9%)1,628 (3.7%)0.2
    Age < 6525,346 (61%)26,540 (60%)<0.001
    Age 65 or older15,983 (39%)17,828 (40%)<0.001
    Baby Boomer41,329 (100%)44,368 (100%)
    Hispanic/Latino1,234 (3.0%)1,378 (3.1%)0.3
    Gender – Female23,929 (58%)25,364 (57%)0.030
    In Person28,763 (70%)30,588 (69%)0.038
    Site Name<0.001
     Practice 12,331 (5.6%)2,115 (4.8%)
     Practice 21,796 (4.3%)5,049 (11%)
     Practice 33,344 (8.1%)3,260 (7.3%)
     Practice 43,912 (9.5%)1,269 (2.9%)
     Practice 5763 (1.8%)2,304 (5.2%)
     Practice 61,411 (3.4%)4,637 (10%)
     Practice 712,630 (31%)12,292 (28%)
     Practice 82,106 (5.1%)563 (1.3%)
     Practice 92,774 (6.7%)791 (1.8%)
     Practice 101,623 (3.9%)4,767 (11%)
     Practice 11613 (1.5%)1,743 (3.9%)
     Practice 121,555 (3.8%)482 (1.1%)
     Practice 131,798 (4.4%)1,901 (4.3%)
     Practice 141,946 (4.7%)576 (1.3%)
     Practice 152,727 (6.6%)2,619 (5.9%)
    • 1n (%).

    • 2Pearson's χ2 test.

    • View popup
    Table 3.

    Generalized Linear Mixed Model Results

    VariableBeta (SE)OR
    Constant−3.327*** (0.395)0.0360.0170.078
    Intervention−0.032 (0.090)0.9690.8121.155
    In Person0.210 (0.528)1.2340.4383.475
    Gender - Female−0.141*** (0.034)0.8680.8130.927
    Less than 650.293*** (0.035)1.3401.2511.436
    African American−0.052 (0.041)0.9490.8751.029
    Asian0.203* (0.113)1.2250.9821.527
    Multi-Race/Other−0.092 (0.093)0.9120.7601.094
    Hispanic/Latino0.039 (0.096)1.0390.8611.254
    Time Period 2−0.202*** (0.053)0.8170.7360.906
    Time Period 3−0.089 (0.068)0.9150.8021.045
    Time Period 4−0.064 (0.079)0.9380.8031.095
    Intervention: In Person0.259*** (0.085)1.2961.0981.529
    Observations85,697
    Log Likelihood−14,656.500
    Akaike Inf. Crit.29,340.990
    Bayesian Inf. Crit.29,472.010
    • Abbreviations: SE, standard error; OR, odds ratio.

    • ↵*P < .1; **P < .05; ***P < .01.

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The Journal of the American Board of Family     Medicine: 35 (5)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 5
September/October 2022
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Primary Care Evaluation of a Hepatitis C Virus (HCV) Screening Education Intervention
Thomas Ludden, Lindsay Shade, Jeremy Thomas, Mark W. Russo, Michael Leonard, Philippe J. Zamor, Charity G. Patterson, Hazel Tapp
The Journal of the American Board of Family Medicine Oct 2022, 35 (5) 990-997; DOI: 10.3122/jabfm.2022.05.210508

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Primary Care Evaluation of a Hepatitis C Virus (HCV) Screening Education Intervention
Thomas Ludden, Lindsay Shade, Jeremy Thomas, Mark W. Russo, Michael Leonard, Philippe J. Zamor, Charity G. Patterson, Hazel Tapp
The Journal of the American Board of Family Medicine Oct 2022, 35 (5) 990-997; DOI: 10.3122/jabfm.2022.05.210508
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