乌鸦传媒

This article is a collaboration between 乌鸦传媒 and:

WASHINGTON -- Electronic alerts can dramatically increase the number of hepatitis C virus (HCV) tests doctors order for baby boomer patients, researchers reported here.

Two studies, from medical groups in the Midwest and in central Texas, showed almost identical results -- a 10-fold increase in the number of baby boomer patients tested for the virus after a pop-up reminder was added to electronic medical record (EMR) systems.

But both studies, presented at the Liver Meeting, the annual conference of the American Association for the Study of Liver Diseases, also showed that the tested patients were only a small proportion of the baby boomers who should have been offered a test under the guidelines of the

Those 2013 guidelines said that all patients born between 1945 and 1965 should be offered an HCV test at least once as part of routine care. The recommendation was an addition to older guidelines that suggested testing based on various categories of risk, and essentially said that being a baby boomer was an important risk category all by itself.

The bottom line is "EMR alerts work," said Robyn Teply, PharmD, of Creighton University in Omaha, Nebraska.

The study by Teply's group assessed what happened in 35 primary care clinics in eastern Nebraska and southwest Iowa when an EMR prompt was initiated to identify patients in need of HCV screening.

The group analyzed the records and looked at the 4 months before the prompt was added -- from Aug.1, 2016 through Nov. 30, 2016 -- and compared that with the following 4 months.

In both periods, about the same number of baby boomer patients were seen in the clinics -- 29,703 before the prompt and 29,913 after -- and the groups did not differ statistically, Teply told 乌鸦传媒.

But the number of baby boomers screened was sharply different: 482 versus 5,685, or more than 10-fold. The proportion screened also rose from 1.62% to 19%, she said.

Interestingly, 20 of the 482 patients (4.15%) screened before the prompt was initiated had antibodies for HCV, compared with 107 in the post-prompt group, or 1.88%. That difference was probably because doctors had been testing people when they a reason to suspect HCV other than age, Teply said.

In the second study, researchers in central Texas found a very similar pattern, according to Hannah Jones, DO, of the Baylor Scott & White health system in Temple.

The investigators looked at records for a year before and after they initiated an EMR prompt in February 2015, and saw a sharp increase in screening, from about 2,500 tests in the year before the prompt initiation to about 28,000 in the following year.

The proportion rose from 1.87% of baby boomer patients to 14.14%, a difference that was statistically significant, Jones said.

In both studies, however, the proportion tested was only a fraction of those eligible for screening under the USPSTF guidelines.

"We have an increase overall, but there's still a large patient population not being screened," Jones told 乌鸦传媒.

That's not necessarily because doctors are ignoring the prompts, she said. In many cases, patients might refuse the test, and in some cases -- during a short appointment for an acute illness, for instance -- it may have been inappropriate to suggest a blood test for HCV, Jones added.

But as patients return repeatedly for routine care, the prompts should begin to capture more and more of the boomer population, Teply suggested.

In a study that sheds a different light on the issue, Janna Manjelievskaia, a PhD candidate at the University of the Sciences in Philadelphia, reported that primary care doctors are aware of the screening guidelines, but in many cases don't know, and can't calculate, how often they screen patients.

Manjelievskaia's group sent a two-page survey to 1,500 randomly selected members of the American Academy of Family Physicians, asking about HCV screening, and got responses from 357 (29%).

Slightly fewer than two-thirds (63.5%) said they were very aware of the USPSTF guidelines but only a third thought screening of boomers was extremely important. Indeed, on a list of standard tests doctors thought were important -- for hypertension, colorectal cancer, diabetes, and several others -- HCV screening was dead last.

"It was consistently ranked the lowest priority," she said.

Importantly, only 59% of the respondents gave even an estimate of how many boomers they screened, saying they did not know or could not calculate a rate, Manjelievskaia told 乌鸦传媒. Of the estimates,most reported screening rates of well below 67%, she added.