Source

Mari-Lynn Drainoni, Elisa A. Koppelman, and Cindy L. Christiansen are with the Department of Health and Policy Management, Boston University School of Public Health, Boston, MA. Alain H. Litwin is with the Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY. Bryce D. Smith and Cindy M. Weinbaum are with the Division of Viral Hepatitis, National Center for HIV/Viral Hepatitis/STD/TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA. M. Diane McKee is with the Department of Family Medicine, Albert Einstein College of Medicine and Montefiore Medical Center. Allen L. Gifford is with the VA HIV/Hepatitis Quality Enhancement Research Initiative, Edith Nourse Rogers Memorial Veterans Administration Hospital, Bedford, MA. William N. Southern is with the Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center.

Abstract

Objectives. We evaluated an intervention designed to identify patients at risk for hepatitis C virus (HCV) through a risk screener used by primary care providers. Methods. A clinical reminder sticker prompted physicians at 3 urban clinics to screen patients for 12 risk factors and order HCV testing if any risks were present. Risk factor data were collected from the sticker; demographic and testing data were extracted from electronic medical records. We used the t test, χ(2) test, and rank-sum test to compare patients who had and had not been screened and developed an analytic model to identify the incremental value of each element of the screener. Results. Among screened patients, 27.8% (n = 902) were identified as having at least 1 risk factor. Of screened patients with risk factors, 55.4% (n = 500) were tested for HCV. Our analysis showed that 7 elements (injection drug use, intranasal drug use, elevated alanine aminotransferase, transfusions before 1992, ≥ 20 lifetime sex partners, maternal HCV, existing liver disease) accounted for all HCV infections identified. Conclusions. A brief risk screener with a paper-based clinical reminder was effective in increasing HCV testing in a primary care setting.