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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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Mkuu RS, Shenkman EA, Muller KE, Huo T, Salloum RG, Cabrera R, Zarrinpar A, Thomas E, Szurek SM, Nelson DR. Do patients at high risk for Hepatitis C receive recommended testing? A retrospective cohort study of statewide Medicaid claims linked with OneFlorida clinical data. Medicine (Baltimore) 2021; 100:e28316. [PMID: 34918711 PMCID: PMC8677982 DOI: 10.1097/md.0000000000028316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Hepatitis C virus (HCV) infection is a leading risk factor for hepatocellular carcinoma.We employed a retrospective cohort study design and analyzed 2012-2018 Medicaid claims linked with electronic health records data from the OneFlorida Data Trust, a statewide data repository containing electronic health records data for 15.07 million Floridians from 11 health care systems. Only adult patients at high-risk for HCV (n = 30,113), defined by diagnosis of: HIV/AIDS (20%), substance use disorder (64%), or sexually transmitted infections (22%) were included. Logistic regression examined factors associated with meeting the recommended sequence of HCV testing.Overall, 44.1% received an HCV test. The odds of receiving an initial test were significantly higher for pregnant females (odds ratio [OR]1.99; 95% confidence interval [CI] 1.86-2.12; P < .001) and increased with age (OR 1.01; 95% CI 1.00-1.01; P < .001).Among patients with low Charlson comorbidity index (CCI = 1), non-Hispanic (NH) black patients (OR 0.86; 95% CI 0.81-0.9; P < .001) had lower odds of getting an HCV test; however, NH black patients with CCI = 10 had higher odds (OR 1.41; 95% CI 1.21-1.66; P < .001) of receiving a test. Of those who tested negative during initial testing, 17% received a second recommended test after 6 to 24 months. Medicaid-Medicare dual eligible patients, those with high CCI (OR 1.14; 95% CI 1.11-1.17; P < .001), NH blacks (OR 1.93; 95% CI 1.61-2.32; P < .001), and Hispanics (OR 1.49; 95% CI 1.08-2.06; P = .02) were significantly more likely to have received a second HCV test, while pregnant females (OR 0.71; 95% CI 0.57-0.89; P = .003), had lower odds of receiving it. The majority of patients who tested positive during the initial test (97%) received subsequent testing.We observed suboptimal adherence to the recommended HCV testing among high-risk patients underscoring the need for tailored interventions aimed at successfully navigating high-risk individuals through the HCV screening process. Future interventional studies targeting multilevel factors, including patients, clinicians and health systems are needed to increase HCV screening rates for high-risk populations.
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Affiliation(s)
- Rahma S. Mkuu
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Elizabeth A. Shenkman
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Keith E. Muller
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Tianyao Huo
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Ramzi G. Salloum
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Roniel Cabrera
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Ali Zarrinpar
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL
| | - Emmanuel Thomas
- Department of Pathology, University of Miami Health System, Miami, FL
| | - Sarah M. Szurek
- Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - David R. Nelson
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL
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Zucker J, Carnevale C, Theodore D, Castor D, Meyers K, Gold J, Winetsky D, Scherer M, Cohall A, Gordon P, Sobieszczyk M, Olender S. Attitudes and Perceived Barriers to Sexually Transmitted Infection Screening Among Graduate Medical Trainees. Sex Transm Dis 2021; 48:e149-e152. [PMID: 34110753 PMCID: PMC8462979 DOI: 10.1097/olq.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABSTRACT Graduate medical training is an opportune time to improve provider delivery of sexually transmitted infection (STI) screening. A survey of trainees found that the majority feel STI screening is their job but identified barriers to successful screening. Training that intentionally address service-specific barriers will be valuable in ending the STI epidemic.
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Affiliation(s)
- Jason Zucker
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | | | - Deborah Theodore
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Delivette Castor
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center at Vagelos College of Physicians and Surgeons
| | - Jeremy Gold
- Department of Internal Medicine, Columbia University Irving Medical Center
| | - Daniel Winetsky
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
- HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute
| | - Matt Scherer
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Alwyn Cohall
- Department of Pediatrics, Columbia University Irving Medical Center
| | - Peter Gordon
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Magdalena Sobieszczyk
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Susan Olender
- Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
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5
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Zucker J, Carnevale C, Theodore D, Castor D, Meyers K, Gold J, Winetsky D, Scherer M, Cohall A, Gordon P, Sobieszczyk M, Olender S. Attitudes and Perceived Barriers to Routine HIV Screening and Provision and Linkage of Postexposure Prophylaxis and Pre-Exposure Prophylaxis Among Graduate Medical Trainees. AIDS Patient Care STDS 2021; 35:180-187. [PMID: 33901410 PMCID: PMC8106251 DOI: 10.1089/apc.2021.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
New York City is the metropolitan area in the United States with the highest number of new HIV diagnoses nationwide. The End-The-Epidemic (EtE) initiative calls for identifying persons with HIV who remain undiagnosed, linking and retaining persons living with HIV to maximize viral suppression, and facilitate access to pre-exposure prophylaxis (PrEP) for patients at increased risk of HIV. HIV screening represents the first step to both the primary and secondary HIV prevention cascades. We conducted an online, anonymous, cross-sectional survey of residents at all stages of training within four residency programs at one institution in Northern Manhattan between August 2017 and August 2018. All internal medicine, emergency medicine, obstetrics and gynecology trainees, and pediatrics were invited to complete the survey via email. Of 298 eligible trainees, 142 (48%) completed the survey. Most trainees were aware of the HIV testing law and agreed that HIV testing was their responsibility, but few successfully screened most of their patients. Most trainees were not knowledgeable about non-occupational post-exposure prophylaxis (nPEP) or PrEP, but felt that it was important to provide these services across settings. Barriers to HIV, nPEP, and PrEP varied across specialties. Ending the HIV epidemic will require efforts across clinical specialties. In this survey from an EtE jurisdiction, most trainees felt that it is important to provide HIV prevention services in most settings; however, their knowledge and comfort with HIV prevention services other than testing were low. Barriers varied across specialties, and developing specialty-specific materials for trainees may be beneficial.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Caroline Carnevale
- New York-Presbyterian Hospital HIV Prevention Program, New York, New York, USA
| | - Deborah Theodore
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Delivette Castor
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center at Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jeremy Gold
- Department of Internal Medicine and Columbia University Irving Medical Center, New York, USA
| | - Daniel Winetsky
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew Scherer
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Alwyn Cohall
- Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Prince DS, Pipicella JL, Fraser M, Alvaro F, Maley M, Foo H, Middleton PM, Davison SA, Dore GJ, McCaughan GW, Levy MT. Screening Emergency Admissions at Risk of Chronic Hepatitis C (SEARCH) to diagnose or 're-diagnose' infections is effective in Australia. J Viral Hepat 2021; 28:121-128. [PMID: 32869904 DOI: 10.1111/jvh.13393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/13/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022]
Abstract
The World Health Organization has set ambitious viral hepatitis elimination targets; however, difficulties in identifying and engaging patients remain. The emergency visit is an opportunity for enhanced linkage to care (LTC). We assessed the effectiveness of an automated Emergency Department (ED) screening service in identifying patients with hepatitis C (HCV) and achieving LTC. A retrospective evaluation was undertaken, analysing the first 5000 patients screened through an automatic Australian service termed 'Screening Emergency Admissions at Risk of Chronic Hepatitis' (SEARCH). Screening was performed for those recommended in the Australian national testing policy, specifically overseas born (OB) and Aboriginal or Torres Strait Islanders (ATSI). Healthcare worker education, patient information materials and opt-out informed consent were used to test sera already collected for biochemistry assays. 5000 of 5801 (86.2%) consecutive eligible patients were screened (OB: 4778, ATSI: 222) from 14 093 ED presentations. HCV antibody was positive in 181 patients (3.6%); 51 (1.0%) were HCV RNA positive. Of 51 HCV RNA-positive patients, 12 were new diagnoses, 32 were 're-diagnoses' (aware but lost to follow-up [LTFU]), and 7 were previously known but treatment contraindicated. LTC was successful in 38 viraemic patients (7 deceased, 4 LTFU, 1 treatment ineligible and 1 declined). Of RNA-negative patients, 75 were previously treated and 49 had presumed spontaneous clearance. Opt-out consent was acceptable to all patients and staff involved. ED screening can lead to additional diagnosing and 're-diagnosing' of HCV, with high rates of LTC. Opt-out consent and automation removed major obstacles to testing.
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Affiliation(s)
- David Stephen Prince
- Liverpool Hospital, Sydney, NSW, Australia.,The University of New South Wales, Sydney, NSW, Australia
| | - Joseph Louis Pipicella
- Liverpool Hospital, Sydney, NSW, Australia.,The Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | | | - Frank Alvaro
- Liverpool Hospital, Sydney, NSW, Australia.,NSW Health Pathology, Liverpool, NSW, Australia
| | - Michael Maley
- Liverpool Hospital, Sydney, NSW, Australia.,The University of New South Wales, Sydney, NSW, Australia.,NSW Health Pathology, Liverpool, NSW, Australia
| | - Hong Foo
- Liverpool Hospital, Sydney, NSW, Australia.,NSW Health Pathology, Liverpool, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Paul MacConachie Middleton
- Liverpool Hospital, Sydney, NSW, Australia.,The University of New South Wales, Sydney, NSW, Australia.,The Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Emergency Research Institute, UNSW, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Scott Anthony Davison
- Liverpool Hospital, Sydney, NSW, Australia.,The University of New South Wales, Sydney, NSW, Australia
| | - Greg John Dore
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Geoff William McCaughan
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Miriam Tania Levy
- Liverpool Hospital, Sydney, NSW, Australia.,The University of New South Wales, Sydney, NSW, Australia.,The Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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