Affixing a reminder sticker that lists risk factors for hepatitis C virus (HCV) infection onto patients’ medical charts can be effective in increasing the number of patients sent for HCV testing by their primary care physicians. It also boosts the number of patients found HCV-positive, according to a new study.
HCV is the leading cause of liver failure in the United States, accounting for 15,000 deaths in 2007 and 3.2 million Americans with chronic HCV infection. Although new antiviral treatments promise to greatly reduce the burden of HCV-related disease, a majority of HCV-positive patients (45–85 percent) are unaware that they are infected.
To increase screening, the researchers developed a 2-ply (carbon copy) sticker with a list of 12 HCV infection-related risk factors (with yes and no check boxes) and 2 items about HCV testing (Was patient tested recently? Was an HCV test ordered?). The stickers, affixed to each patient’s chart, reminded the physician to ask about HCV risk factors. The top sheet could be detached for later data analysis, while the bottom sheet remained in the patient’s chart. The physicians saw 8,891 patients over the 15-week study period who had not undergone a recent anti-HCV antibody test. Screener pages were completed for 3,250 (36.2 percent of patients), with significant racial and gender-related differences in screening rates.
Overall, 27.8 percent of those screened had at least one risk factor. More than half (55.4 percent) of patients with any risk factors—and 13.7 percent of those with no identified risk—underwent HCV testing, yielding infection rates of 6.8 percent and 2.2 percent, respectively. Seven of the risk factors, including ever use of injected or snorted drugs, accounted for 82.9 percent of the 41 HCV-positive patients, but another 7 HCV-positive patients had no risk factors when screened. The researchers collected data from three urban clinics that instituted the use of the stickers with all adult patients and HCV testing based primarily on the presence of HCV risk factors as part of the Hepatitis C Assessment and Testing project.
The study was funded by AHRQ (Contract No. 290-06-0012). More details are in "Effectiveness of a risk screener in identifying hepatitis C virus in a primary care setting," by Mari-Lynn Drainoni, Ph.D., Alain H. Litwin, M.D., Bryce D. Smith, Ph.D., and others in the November 2012 American Journal of Public Health 102(11), pp. e115-e121.