Sperring Heather, Ruiz-Mercado Glorimar, Schechter-Perkins Elissa M
Boston Medical Center, Boston, MA, USA.
Boston University School of Medicine, Boston, MA, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720969554. doi: 10.1177/2150132720969554.
Coronavirus disease 2019 (COVID-19) has led to unprecedented modifications to healthcare delivery in the U.S. To preserve resources in preparation for a COVID-19 surge, Boston Medical Center (BMC) implemented workflows to decrease ambulatory in-person visits effective March 16th, 2020. Telemedicine was incorporated into clinical workflows and much preventive care, including Hepatitis C (HCV) testing, was not routinely performed.
To explore the impact that the COVID-19 rapid restructuring response has had on HCV testing and identification hospital-wide and in ambulatory settings.
BMC utilizes reflex confirmatory testing for HCV. When a sample is HCV Ab positive, it is automatically reflexed for confirmatory RNA and genotype testing. HCV test results for patients were collected daily. We compared unique patient tests for 3.5 month periods before and after March 16th, 2020. Descriptive statistics showed total tests and total new HCV RNA+ before versus after, both hospital-wide and in ambulatory clinics alone. Mean daily tests completed were compared.
Hospital-wide, total HCV testing decreased by 49.6%, and new HCV+ patient identification decreased by 42.1%. In ambulatory clinics, testing decreased by 71.9%, and new HCV+ identification decreased by 63.3%. Hospital-wide, mean daily tests decreased by 22.9 tests per day (95% CI: 17.9-28.0, < .001), and mean daily new HCV+ identification decreased by 0.36 (95% CI: 0.20-0.53, < .001). In ambulatory clinics, mean daily tests decreased by 22.1 tests per day (95% CI: 17.5-26.7, < .001) and mean daily HCV+ decreased by 1.40 (95% CI: 1.03-1.76, < .001).
The COVID-19 systematic emergency response led to decreased HCV testing and identification, and in this regard telemedicine acts as a barrier to HCV care. Other public health initiatives must be monitored in the context of telemedicine workflows. Continued monitoring of HCV screening trends is vital, and adaptive approaches to work toward the goal of HCV elimination are needed.
2019年冠状病毒病（COVID-19）给美国的医疗服务带来了前所未有的改变。为了储备资源以应对COVID-19的激增，波士顿医疗中心（BMC）自2020年3月16日起实施了相关工作流程，以减少门诊面对面就诊。远程医疗被纳入临床工作流程，许多预防性护理，包括丙型肝炎（HCV）检测，都未常规开展。
探讨COVID-19快速重组应对措施对全院及门诊环境中HCV检测和识别的影响。
BMC对HCV采用反射性确证检测。当样本HCV抗体呈阳性时，会自动进行确证RNA和基因分型检测。每天收集患者的HCV检测结果。我们比较了2020年3月16日前后3.5个月期间的独特患者检测情况。描述性统计显示了全院及仅门诊诊所前后的总检测数和新的HCV RNA阳性总数。比较了每日完成的平均检测数。
在全院范围内，HCV总检测量下降了49.6%，新的HCV阳性患者识别数下降了42.1%。在门诊诊所，检测量下降了71.9%，新的HCV阳性识别数下降了63.3%。在全院范围内，每日平均检测数每天减少22.9次（95%置信区间：17.9 - 28.0，P <.001），每日新的HCV阳性识别数平均减少0.36（95%置信区间：0.20 - 0.53，P <.001）。在门诊诊所，每日平均检测数每天减少22.1次（95%置信区间：17.5 - 26.7，P <.001），每日HCV阳性数平均减少1.40（95%置信区间：1.03 - 1.76，P <.001）。
COVID-19系统性应急响应导致HCV检测和识别减少，在这方面远程医疗成为HCV护理的障碍。在远程医疗工作流程的背景下，必须对其他公共卫生举措进行监测。持续监测HCV筛查趋势至关重要，需要采取适应性方法朝着消除HCV的目标努力。
