Department of Health and Policy Management, Boston University School of Public Health, Boston, MA, USA.
Am J Public Health. 2012 Nov;102(11):e115-21. doi: 10.2105/AJPH.2012.300659. Epub 2012 Sep 20.
We evaluated an intervention designed to identify patients at risk for hepatitis C virus (HCV) through a risk screener used by primary care providers.
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.
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.
A brief risk screener with a paper-based clinical reminder was effective in increasing HCV testing in a primary care setting.
我们评估了一项通过初级保健提供者使用的风险筛查器来识别丙型肝炎病毒（HCV）感染风险患者的干预措施。
临床提醒贴纸提示 3 家城市诊所的医生筛查患者是否存在 12 种风险因素，并在存在任何风险时进行 HCV 检测。从贴纸中收集风险因素数据；从电子病历中提取人口统计学和检测数据。我们使用 t 检验、卡方检验和秩和检验比较已筛查和未筛查患者，并开发分析模型以确定筛查器各要素的增量价值。
在接受筛查的患者中，有 27.8%（n=902）被确定至少存在 1 个风险因素。在有风险因素的筛查患者中，有 55.4%（n=500）接受了 HCV 检测。我们的分析表明，7 个要素（注射吸毒、鼻内吸毒、丙氨酸氨基转移酶升高、1992 年前的输血、≥20 个性伴侣、母婴 HCV、现有肝脏疾病）可以发现所有 HCV 感染。
使用纸质临床提醒的简短风险筛查器在初级保健环境中有效增加了 HCV 检测。
