Vadaparampil Susan T, Fuzzell Lindsay N, Rathwell Julie, Reich Richard R, Roetzheim Richard, Giuliano Anna R
Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA.
Healthcare (Basel). 2023 Jan 10;11(2):209. doi: 10.3390/healthcare11020209.
Approximately three million people in the United States have been exposed to the hepatitis C virus (HCV), with two-thirds of these having chronic HCV infection. Baby boomers (those born 1945-1965) have nearly five times the prevalence of HCV infection compared with other age groups. Despite clinical practice guidelines that recommend HCV testing in baby boomers, the testing rates remain low. We developed and tested a multilevel intervention to increase orders for HCV testing that included integrated clinical decision support within the electronic health record (EHR) and a physician education session to improve HCV physician knowledge in one Florida academic health system. In the year prior to the intervention, test order rates for encounters with baby boomers was 11.9%. During the intervention period (August 2019-July 2020) for providers that viewed a best practice alert (BPA), the ordering increased to 59.2% in Family Medicine and 64.6% in Internal Medicine. The brief physician education intervention improved total HCV knowledge and increased self-efficacy in knowledge of HCV risk factors. These findings suggest that interventions at the system and physician levels hold promise for increasing HCV testing rates. Future studies are needed to evaluate this intervention in additional clinical settings and to test the benefit of adding additional intervention components that are directed at patients.
在美国，约有300万人接触过丙型肝炎病毒（HCV），其中三分之二患有慢性HCV感染。婴儿潮一代（出生于1945年至1965年的人）感染HCV的患病率是其他年龄组的近五倍。尽管临床实践指南建议对婴儿潮一代进行HCV检测，但检测率仍然很低。我们开发并测试了一种多层次干预措施，以增加HCV检测的医嘱，该措施包括电子健康记录（EHR）中的综合临床决策支持以及在佛罗里达州的一个学术医疗系统中开展的医生教育课程，以提高医生对HCV的认识。在干预前的一年中，与婴儿潮一代接触的检测医嘱率为11.9%。在干预期间（2019年8月至2020年7月），对于查看了最佳实践警报（BPA）的提供者，家庭医学的医嘱率提高到59.2%，内科的医嘱率提高到64.6%。简短的医生教育干预提高了HCV的总体知识水平，并增强了对HCV危险因素知识的自我效能感。这些发现表明，系统和医生层面的干预措施有望提高HCV检测率。未来需要开展研究，在更多临床环境中评估这种干预措施，并测试增加针对患者的其他干预成分的益处。
