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Evaluating a hepatitis c quality gap: missed opportunities for HCV-related cares
Yang Liu, Renee H Lawrence, Yngve Falck-Ytter
1HIV/Hepatitis Clinical Pharmacy Specialist, Louis Stokes Cleveland VA Medical Center, Pharmacy Service, 10701 East Blvd, Cleveland, OH 44106.
Insights
Many patients with positive hepatitis C antibody (HCVab) tests do not complete viral RNA testing. Healthcare systems must improve HCV diagnosis to ensure timely and accurate patient care.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) diagnosis requires a two-step process: antibody (HCVab) testing followed by viral RNA testing.
- A significant care gap exists for individuals with positive HCVab results who do not complete confirmatory viral RNA testing, leaving their HCV status undetermined.
Purpose of the Study:
- To investigate the extent of HCV-related care provided to patients within this diagnostic care gap.
- To describe provider acknowledgment of positive HCVab results and subsequent clinical actions taken.
Main Methods:
- Retrospective cohort study analyzing electronic medical records (EMRs) of patients with positive HCVab tests who did not complete viral RNA testing.
- Reviewed EMRs for provider acknowledgment of positive HCVab results, documentation of chronic HCV diagnosis, and performance of clinical actions within one year.
Main Results:
- Provider acknowledgment of positive HCVab results was missing in 31% of subjects.
- Chronic HCV was added to the problem list in 35% of cases, increasing subsequent documentation.
- Among patients with recommended actions, 45% received HCV education and 42% had liver enzyme monitoring.
Conclusions:
- Healthcare systems must optimize the HCV diagnostic pathway to ensure accurate and timely diagnosis.
- Addressing the care gap in HCV testing is crucial for patient well-being, especially with improved treatments available.
Objectives:
Diagnosis of chronic hepatitis C virus (HCV) is a 2-step process involving hepatitis C antibody (HCVab) testing followed by viral ribonucleic acid (RNA) testing. The HCV status of those with a positive HCVab without viral testing cannot be determined. This study sought to describe the HCV-related care provided to patients in this care gap.
Study Design:
Retrospective cohort study of active patients with a positive HCVab test who did not complete viral testing.
Methods:
Electronic medical records (EMRs) were reviewed to determine if each subject's first positive HCVab result was acknowledged by a provider. For results acknowledged, we described provider actions in response to the result. When providers performed specific clinical actions within 1 year of the positive HCVab test, we captured the type of action taken. When the unsubstantiated diagnosis was documented in the EMR, we determined if the diagnosis was mentioned by subsequent providers.
Results:
Positive HCVab results were not acknowledged in 31% of subjects. In 35%, providers added chronic HCV to the problem list in the EMR, resulting in a higher likelihood of subsequent providers mentioning the diagnosis in their EMR documentation. In 143 subjects whose providers recommended HCV-related clinical actions within 1 year of the positive result, 45% were educated about HCV and 42% had their liver enzymes monitored.
Conclusions:
With more widespread testing anticipated and more effective treatments available, health systems should ensure the HCV diagnostic process results in the delivery of an accurate and timely HCV diagnosis, to reduce the risk of harm to patients.
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