Abstract 17 Improving Counseling and Interventions to Reduce HCV Transmission and Liver Disease Progression in Patients With Non-cirrhotic Chronic HCV Infection

Abstract

Current AASLD guidelines recommend measures directed at reducing HCV transmission and liver disease progression in patients with active HCV infection. These measures are routinely addressed in patients with cirrhosis; however, they can be overlooked in patients with non-cirrhotic chronic HCV infection. Our aim was to design an intervention to improve counseling and interventions in patients with non-cirrhotic chronic HCV infection. An electronic medical record (EMR) template was designed to be used with all encounters for chronic HCV infection in a fellow’s continuity clinic during the second year of fellowship. Patients with cirrhosis were excluded from the analysis. The template included a progress note with reminders to assess HAV and HBV immunity, HIV and HBV coinfection, liver fibrosis, and alcohol use at each visit. The template also included patient instructions addressing resources for alcohol cessation counseling, when applicable, and education on HCV transmission prevention. The frequencies at which these measures were assessed in year 2 were compared with year 1 when the template was not used. Statistical significance was assessed using a two-tailed Fisher’s exact test. There were a total of 45 patient encounters for non-cirrhotic chronic HCV during the study period, 25 during year 1 and 20 during year 2. The assessment of HAV and HBV immunity (44% vs 90%, P = .0017), HIV coinfection (28% vs 95%, P = .0001), and HCV transmission prevention (8% vs 95%, P = .0001) each improved significantly between year 1 and year 2. The assessment of HBV coinfection (72% vs 95%, P = .0592), liver fibrosis (80% vs 100%, P = .0562), and alcohol use (72% vs 95%, P = .0592) each showed a trend toward improvement, but were not statistically significant between year 1 and year 2. Counseling and interventions to reduce HCV transmission and liver disease progression are an important aspect of the care of patients with non-cirrhotic chronic HCV infection. A simple EMR template can improve patient care and adherence to current guidelines.