Hepatitis C virus screening for baby boomers found to be lacking

Liz Meszaros, MDLinx

Digestive Disease Week® (DDW)

San Diego, California, United States | May 21-24, 2016

Advertisement

San Diego, CA, May 22, 2016—In a large cohort of minority patients, almost 75% of those eligible for hepatitis C virus (HCV) screening admitted as inpatients in an internal medicine service in New York remained unscreened, according to researchers here at Digestive Disease Week 2016.

Take-home messages

  • All adults born between 1945 and 1965 must be screened for hepatitis C virus, according to the screening process mandated by the Centers for Disease Control and Prevention and United States Preventive Services Task Force and signed into law by Governor Andrew Cuomo of New York on January 1, 2014.
  • Almost 75% of those eligible for HCV screening admitted as inpatients in an internal medicine service in New York remained unscreened.

In a screening process mandated by the Centers for Disease Control and Prevention and United States Preventive Services Task Force and signed into law by Governor Andrew Cuomo of New York on January 1, 2014, all adults who were born between 1945 and 1965 must be screened for HCV. Lead researcher Rashmee Patil, MD, internal medicine physician, Mount Sinai St. Luke’s Roosevelt, New York, NY, and fellow researchers conducted this retrospective, quality improvement project between January 2014 and March 2015 to determine the rate of HCV in baby boomers who had been screened by internal medicine residents upon admission at a teaching community hospital.

Researchers collected information, including patient year of birth, gender, and HCV testing by antibody (Ab) and/or HCV RNA at any point during inpatient admission. As built-in by the IT department, HCV screening was included as a mandatory step, and residents were prompted, via computer, to ask the patients they were admitting for consent to screen for HCV. If the patient refused, they required documentation of the refusal to finish admitting the patient.

Dr. Patil and colleagues reviewed 2,534 charts, and noted that 25.6% had HCV screening tests done, 5.4% tested positive for HCV Ab, and 94.6% were HCV Ab-negative. In all, 33% of patients were not screened due to inaccurate recording of date of birth. A total of 13% of patients declined to be screened, while 4.9% were not screened because of altered mental status that prohibited them from giving consent. Finally, 2.7% had the test ordered, but it was not sent to the laboratory, and 164 patients had undergone prior HCV testing.

Almost 75% of patients eligible for HCV screening who were admitted to an inpatient internal medicine service were not screened.

In addition, researchers found a higher seroprevalence of HCV compared with the US general population in this primarily minority cohort (1.6%).

“We found that a large number of [patients] went unscreened due to issues with electronic health record as well as resident physicians circumventing these screenings for various reasons,” said Dr. Patil.

Thus, they concluded, despite the quality improvement measures implemented through IT for HCV testing on admission, education and intervention are necessary to increase screening uptake, and decrease physician-related barriers to HCV screening.

“Screening patients is paramount because now we have curative therapy for HCV. These patients give us a good opportunity to screen in the outpatient setting, because they are from a lower socioeconomic background and may not have access to care as an outpatient. When they’re inpatients, we have a unique opportunity to screen them,” noted Dr. Patil.

“But there are still barriers to screening. We can improve on that by improving our electronic health records, by creating hard stops throughout the inpatient admission—from the emergency room to the inpatient floor setting—to continue to screen them, and give alerts to the physicians, reminders for screening,” she concluded.

Advertisement