Thomas Ludden, PhD; Lindsay Shade, PA-C; Jeremy Thomas, MSW; Mark W Russo, MD; Michael Leonard, MD; Philippe J. Zamor; Charity G. Patterson, PhD; Hazel Tapp, PhD
Corresponding Author: Thomas Ludden, PhD; Department of Family Medicine, Atrium Health.
Contact Email: Tom.ludden@atriumhealth.org
Section: Original Research
BACKGROUND: Increased screening efforts and the development of effective antiviral treatments have led to marked improvement in Hepatitis C (HCV) patient outcomes. However, many people in the US are believed to have undiagnosed HCV. Successful screening strategies and access to a coordinated system of care is critical for HCV affected adults . The objective of this study was to evaluate a primary care HCV screening education intervention that took place 2018 to 2019 to improve primary care training and management of patients after the implementation of the electronic medical record (EMR) screening alert.
METHODS: Using 15 primary care practices located in vicinity of neighborhoods at-risk for higher rates of HCV infections, a stepped wedge randomized control study design was utilized to deliver an educational screening intervention. The education intervention was implemented sequentially with 5 practices being presented to every 3 months. Number of patients within the Baby Boomer cohort were collected 3 months before the first practice receiving the intervention to three months after the last practice receiving the education intervention. The main outcome collected was the HCV screening. Generalized linear mixed models were used to test the hypothesis of improved screening rates after intervention implementation.
RESULTS: There were a total of 85,697 patients within the Baby Boomer cohort seen at the 15 practices. Practices receiving the intervention had patients who were more likely to be screened for HCV (β =0.259, p<0.001; Odds Ratio [OR] [95%CI] 1.296 [1.098- 1.529]). In terms of demographics, results showed that females are less likely to be screened than males (β =-0.141, p<0.001; OR [95%CI] 0.868[0.813–0.927]), Baby Boomer patients aged less than 65 were more likely to be screened than Baby Boomer patients aged 65 and older (β =0.293, p<0.001; OR [95%CI] 1.340[1.251–1.436]).
CONCLUSIONS: This study looked at screening rates before and after an educational intervention which happened subsequent to the activation of an EMR alert. While HCV EMR alerts showed an increase in HCV screenings prior to the education intervention, the addition of the education showed a modest increase in HCV screening rates for Baby Boomer patients.