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Laily A, Duncan R, Gabhart KM, Nephew LD, Christy SM, Vadaparampil ST, Giuliano AR, Kasting ML. Differences in Provider Hepatitis C Virus Screening Recommendations by Patient Risk Status. Prev Med Rep 2024; 38:102602. [PMID: 38375175 PMCID: PMC10874862 DOI: 10.1016/j.pmedr.2024.102602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 02/21/2024] Open
Abstract
Providers' recommendation is among the strongest predictors to patients engaging in preventive care. Therefore, the aim of this study was to compare providers' Hepatitis C Virus (HCV) screening recommendation quality between high-risk and average-risk patients to determine if providers are universally recommending HCV screening, regardless of risk behaviors. This cross-sectional survey of 284 Indiana providers in 2020 assessed provider characteristics, HCV screening recommendation practices (strength, presentation, frequency, timeliness), self-efficacy, and barriers to recommending HCV screening. T-test and Chi-square compared recommendation practices for high-risk and average-risk patients. Prevalence ratios were calculated for variables associated with HCV recommendation strength comparing high-risk and average-risk patients. Logistic regression analyses examined factors associated with HCV recommendation strength for high- and average-risk patients, with odds ratios. Compared to average-risk patients, high-risk patients received higher proportion of HCV recommendations that were strong (70.4 % v. 42.4 %), routine (61.9 % v. 55.6 %), frequent (37.7 % v. 28 %), and timely (74.2 % v. 54.9 %) (P-values < 0.001). Compared to average-risk patients, providers with high-risk patients had a lower percentage of giving a strong recommendation if they were nurse practitioner (PR = 0.49). For high-risk patients, providers with higher self-efficacy (aOR = 2.16;95 %CI = 0.99-4.69) had higher odds, while those with higher perceived barriers (aOR = 0.19;95 %CI = 0.09-0.39) and those with an internal medicine specialty compared to family medicine (aOR = 0.22;95 %CI = 0.08-0.57) had lower odds of giving a strong recommendation. These data suggest providers are not universally recommending HCV screening for all adults regardless of reported risk. Future research should translate these findings into multilevel interventions to improve HCV screening recommendations regardless of patient risk status.
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Affiliation(s)
- Alfu Laily
- Department of Public Health, College of Health and Human Sciences, Purdue University, 820 Mitch Daniels Blvd, West Lafayette, IN 47907, USA
| | - Robert Duncan
- Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, 1202 West State St., West Lafayette, IN 47907, USA
| | - Kaitlyn M. Gabhart
- Department of Psychology, Vanderbilt University, 230 Appleton Pl, Nashville, TN 37203, USA
| | - Lauren D. Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN 46202, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Oncological Sciences, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Monica L. Kasting
- Department of Public Health, College of Health and Human Sciences, Purdue University, 820 Mitch Daniels Blvd, West Lafayette, IN 47907, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, 535 Barnhill Dr., Indianapolis, IN 46202, USA
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Zucker J, Purpura L, Sani F, Huang S, Schluger A, Ruperto K, Slowkowski J, Olender S, Scherer M, Castor D, Gordon P. Individualized Provider Feedback Increased HIV and HCV Screening and Identification in a New York City Emergency Department. AIDS Patient Care STDS 2022; 36:106-114. [PMID: 35289689 PMCID: PMC8971984 DOI: 10.1089/apc.2021.0225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Efforts to end the HIV and hepatitis C virus (HCV) epidemics begin with ascertainment of a person's infection status through screening. Despite its importance as a site of testing, missed opportunities for screening in the Emergency Department (ED) are common. We describe the impact of implementing an individualized provider feedback intervention on HIV and HCV testing in a quaternary ED. We conducted an interrupted time series analysis to evaluate the impact of the intervention on weekly HIV and HCV screening in an observational cohort of patients seeking care in the ED. The intervention included a physician champion individualized feedback with peer comparisons to all providers in the ED and an existing HIV/HCV testing and response team. Data were abstracted from the electronic medical record (EMR) for 30 weeks before, during, and after implementing the intervention. We used Poisson regression analysis to estimate changes in the weekly counts and rates of HIV and HCV testing. The incidence rate ratios (IRRs) of HIV testing were 1.94 [95% confidence interval (CI) 1.85-2.04] and 1.38 (95% CI 1.31-1.45) times higher for the intervention and post-intervention period compared with the pre-intervention period. The IRRs of HCV testing was 6.96 (95% CI 6.40-7.58) and 4.70 (95% CI 4.31-5.13) for the intervention and post-intervention periods. There were no meaningful differences in demographic characteristics during the observation period. The intervention meaningfully increased HIV and HCV testing volume and positive case detection, including testing in high-risk groups like young adults and individuals without prior testing. Although diminished, the intervention effect sustained in the 30-week period following implementation.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.,Address correspondence to: Jason Zucker, MD, Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, 622 West 168th Street 8th Floor, New York, NY 10032, USA
| | - Lawrence Purpura
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.,ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Fereshteh Sani
- Acute Care Services, Attending Physician, Emergency Medicine, Permanente Medicine, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Simian Huang
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Aaron Schluger
- Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Kenneth Ruperto
- New York Presbyterian Hospital, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jacek Slowkowski
- New York Presbyterian Hospital, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Matt Scherer
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
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Nontargeted Hepatitis C Screening in an Urban Emergency Department in New York City. J Emerg Med 2020; 60:299-309. [PMID: 33213988 DOI: 10.1016/j.jemermed.2020.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previously the Centers for Disease Control and Prevention (CDC) recommended targeted hepatitis C virus (HCV) screening for adults born between 1945 and 1965 and individuals with HCV risk factors. In April 2020, the CDC updated their recommendations to now include all individuals 18 years of age and older in settings with HCV prevalence > 0.1%. Few emergency departments (EDs) currently employ this nontargeted screening approach. OBJECTIVES We examined how a shift from targeted to nontargeted screening might affect HCV case identification. We hypothesized that nontargeted screening could improve HCV case identification in our ED. METHODS Retrospective review of prospectively collected nontargeted screening data from June 6, 2018 to June 5, 2019 in a large urban academic ED. Patients 18 years of age and older, triaged to the adult or pediatric ED and able to provide consent for HCV testing, were eligible for study inclusion. RESULTS There were 83,864 ED visits and 40,282 unique patients deemed eligible for HCV testing. Testing occurred in 10,630 (26.4%) patients, of which 638 (6%) had positive HCV antibody (Ab+) tests and 214 (2%) had a positive viral load (VL+). Birth cohort-targeted screening would have identified 48% of the patients with Ab+ tests and 47% of those who were VL+. Risk-based targeted screening would increase the number of Ab+ patients to 67% and VL+ to 72%. CONCLUSIONS Nontargeted ED-based HCV screening can identify a large number of patients with HCV infection. A shift from targeted to nontargeted screening may result in fewer missed infections but requires further study.
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Jhaveri R. Screening for Hepatitis C Virus: How Universal Is Universal? Clin Ther 2020; 42:1434-1441. [PMID: 32712026 PMCID: PMC7376340 DOI: 10.1016/j.clinthera.2020.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022]
Abstract
In March and April of 2020, public health authorities issued major updates to screening recommendations for hepatitis C virus infection. With the rise in cases driven by injection drug use coupled with access to highly effective therapies promising a cure, all adults aged ≥18 years should receive one-time hepatitis C virus antibody screening in any health care setting. Although the recommendation is dubbed "universal," this commentary reviews the details of the recommendations and discusses the high-risk populations not entirely captured with these changes.
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Affiliation(s)
- Ravi Jhaveri
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Box 20, Chicago, IL, USA.
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Winetsky D, Zucker J, Carnevale C, Theodore D, Scherer M, Sani F, Elkington K, Cohall A, Sobieszczyk ME, Gordon P, Olender S. Attitudes, practices and perceived barriers to hepatitis C screening among medical residents at a large urban academic medical center. J Viral Hepat 2019; 26:1355-1358. [PMID: 31325394 PMCID: PMC6800582 DOI: 10.1111/jvh.13181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022]
Abstract
Infections with hepatitis C virus (HCV) are increasing among adolescents and adults born after 1965. Screening strategies may need to be adapted for this changing population. We surveyed trainees in different specialties about attitudes and practices related to HCV screening and identified specific barriers to screening across various healthcare settings. Constraints related to health system resources and the provider's role were among the most common barriers cited across specialties, but paediatrics residents also cited barriers specific to their population, which can likely be addressed with targeted education.
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Affiliation(s)
- Daniel Winetsky
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY,HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY
| | - Jason Zucker
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY,Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Caroline Carnevale
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY
| | - Deborah Theodore
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Matthew Scherer
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Fereshteh Sani
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY
| | - Katherine Elkington
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY,Mailman School of Public Health, Columbia University, New York, NY
| | - Alwyn Cohall
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY,Mailman School of Public Health, Columbia University, New York, NY
| | - Magdalena E. Sobieszczyk
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Peter Gordon
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
| | - Susan Olender
- Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY,Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY
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