Please use this thread to discuss the following:

Hepatitis C Treatment and Management Efficacy in a Primary Care Setting

CP3 - Hepatitis C Treatment and Management Efficacy in a Primary Care Setting

Poster Type: Innovation

Category: A. T. Still University; Quality of Care and Quality Improvement

Issue or Challenge: Hepatitis C (HCV) is a highly prevalent infectious disease in Arizona. Despite its prevalence, many primary care providers feel unequipped to screen, diagnose, and treat HCV. This is largely due to the complexity and novel characteristics of HCV treatment along with persistent reliance on specialists to manage this disease. To address the growing burden in northern Arizona, this project aims to improve management of HCV by North Country HealthCare (NCHC) primary care providers (PCP’s) through an educational session on the screening, diagnosis, and treatment of HCV.

Description of Innovation: Once recruited, participants followed the steps for completion that were emailed to them and provided on a recruitment poster. Between March 1-15, 2021, participants completed an electronic pre-survey to assess baseline comfort in screening, diagnosing, and treating HCV. Participants then watched an hour-long pre-recorded educational video presented by a NCHC family physician and resident HCV expert. The video provided guidance on managing HCV positive patients in the primary care office. The presenter expanded on updated USPSTF HCV screening recommendations, 2030 World Health Organization HCV elimination goals, simplified pharmacotherapy for eligible patients, advanced pharmacotherapy for complex patients (non-genotype specific), treatment cessation, treatment restrictions, and monitoring for patient follow-up. Participants completed post-surveys identical to the pre-survey both immediately and two weeks (on or before March 29, 2021) after watching the video to assess change in knowledge and comfortability. The secondary post-survey, administered two weeks after the educational session was intended to assess sustained improvement in HCV management. The survey results were compared using Stata.

Impact or Result: Out of 81 eligible primary care providers at NCHC, ten agreed to complete the educational session (12.3%). Their knowledge of HCV treatment increased by 9.9% immediately after the education (95% CI: -11.6, 31.4; p-value: 0.3468). Providers without previous HCV training had higher average pre-education assessment scores (83.5%) and greater improvement in post-education assessment scores (16.5%) compared to providers with previous training (72.3%; 5.5%). Prevalence of comfortability in screening, diagnosing, and treating HCV increased from 3 to 8 providers, 2 to 7 providers, and 2 to 8 providers respectively. At the two-week follow up, 6 providers responded and scored 100% on the knowledge assessment. All 6 providers selected agree or strongly agree to questions assessing comfort level with screening and diagnosing, and 5 providers chose agree to comfort with treating.

Replicating this Innovation: Organizations may replicate this project by utilizing a provider or group of providers that possess knowledge of HCV management. Next, either a pre-recorded or live educational session could be developed to address HCV management. To incentivize providers to participate, CME credit may be offered, if applicable. Although a limitation within this study, improved participation could be assured by increasing publication of the session amongst providers at the organization. Having resident experts available may also reduce potential barriers as they offer expertise to providers who are new to HCV management. Developing clinic-specific treatment tools and guidelines may also increase sustained knowledge.

Author(s):

Riva Macbeth, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Annalise Wille, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Jasmine Dugal, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Justin Kleinman, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Justin Morin, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Joshua Sturgell, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Luke Allen, MPH, CPH, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Shahim Elja, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Steven Jang, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Rita Bybee, OMS-II, A.T. Still University - School of Osteopathic Medicine in Arizona

Shipra Bansal, MD, A.T. Still University School of Medicine Arizona

Brandon Abbott, DO, North Country HealthCare

Kate Whelihan, MPH, CPH, COPC and Public Health Research Specialist, Department of Public Health, A T Still University School of Osteopathic Medicine

Joy H. Lewis, DO, PhD, FACP, Professor, Medicine and Public Health Chair, SOMA Dept. of Public Health, A T Still University School of Osteopathic Medicine