Hepatitis B Screening of At-Risk Immigrants Seen at Primary Care Clinics: A Quality Improvement Project
Peace N Eneh1, Mohamed Mady1, Mikayla A Schmidt1
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Insights
A simple notification to primary care physicians significantly increased hepatitis B (HBV) screening rates in at-risk immigrant populations. This intervention led to a 4.3-fold increase in screening, aiding early detection and prevention of chronic liver disease.
Area of Science:
- Public Health
- Infectious Diseases
- Primary Care Medicine
Background:
- Chronic hepatitis B virus (HBV) infection affects millions globally, particularly in immigrant populations from high-prevalence regions.
- Screening for HBV in at-risk immigrant groups within primary care settings is crucial for disease management and prevention.
- Current screening rates in these populations are often suboptimal, necessitating targeted interventions.
Purpose of the Study:
- To evaluate the effectiveness of an intervention designed to enhance hepatitis B (HBV) screening among at-risk immigrant patients in primary care.
- To determine if notifying healthcare providers of patient risk status increases HBV screening rates.
- To assess the yield of HBV screening in this identified high-risk population.
Main Methods:
- A cohort of approximately 19,000 immigrant patients from 9 high-risk countries/ethnic groups was identified from a primary care panel.
- Eligible patients without prior HBV testing were identified for inclusion during a 13-month study period.
- An intervention involved notifying primary care professionals via email one week before scheduled visits for at-risk patients, encouraging HBV screening discussions and orders.
Main Results:
- The intervention group showed a 31.4% HBV screening rate compared to 7.2% in the control group.
- This represents a 4.3-fold increase in HBV screening (P<.00001) attributable to the notification intervention.
- Among screened individuals, 21.8% tested positive for prior HBV exposure and 5.9% for chronic HBV infection.
Conclusions:
- Proactive notification of primary care physicians regarding high-risk immigrant patients significantly boosts HBV screening rates.
- This strategy is effective in identifying individuals with HBV, crucial for disease monitoring and prevention.
- Early detection facilitated by increased screening allows for timely management of chronic hepatitis B, preventing severe outcomes like cirrhosis and hepatocellular carcinoma.
Objective:
To test an intervention to increase screening for hepatitis B (HBV) in at-risk immigrants in the primary care setting.
Patients And Methods:
From a Mayo Clinic primary care panel, we identified approximately 19,000 immigrant patients from 9 high-risk countries/ethnic groups with intermediate or high prevalences of chronic HBV. Eligible patients with no record of prior HBV testing scheduled for primary care visits within the study period spanning October 1, 2017, through October 31, 2018, were identified. During the intervention period, the primary health care professional was notified by email 1 week prior to each primary care visit and encouraged to discuss screening for HBV infection and order screening tests at the appointment. We assessed rates of HBV screening during control and intervention periods.
Results:
We identified 597 patients in the control period and 212 patients in the intervention period who had not been screened previously for HBV. During the intervention period, 31.4% (58) of the 185 eligible patients were screened for HBV vs 7.2% (43) of the 597 eligible patients in the control period. Thus, the intervention resulted in a 4.3-fold increase in screening (P<.00001). Of the 101 patients screened in the at-risk population, 22 (21.8%) screened positive for prior exposure to HBV (hepatitis B core antibody-positive) and 6 (5.9%) for chronic HBV infection (hepatitis B surface antigen-positive).
Conclusion:
Notifying primary care physicians of the high-risk status of immigrant patients substantially increased screening for HBV. Identifying patients with HBV is important for monitoring disease prevalence, preventing transmission, and initiating treatment and cancer surveillance, allowing earlier recognition and prevention of chronic hepatitis, disease reactivation, cirrhosis, and hepatocellular carcinoma.
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