Hepatitis C Screening: Are Primary Care Physicians Following the New CDC Guidelines?

Abstract

Purpose: To establish the current hepatitis C virus (HCV) screening rate for patients born between 1945-1965 in the outpatient primary care clinics according to the new Center for Disease Control (CDC) guidelines released in 2012. Methods: We retrospectively reviewed the charts of patients born between January 1, 1945 - December 31, 1965, who presented to two outpatient primary care clinics in Dearborn, MI in the period from December 1, 2012 until April 30, 2013. Information obtained were date of birth, age at presentation, gender, and method of HCV screening (anti-HCV antibody or HCV RNA testing). Results: The total number of charts reviewed is 1,578. Males represented 36% (569) of the total population, and females represented 64% (1,009) of the total population. The mean age for all eligible patients was 56 years, with a standard deviation of 6 years. Two percent (31) of patients from our total enrolled patients were screened for HCV. A higher number of patients (1547) did not receive HCV screening, representing 98% of the toqtal eligible patients. The mean age for the screened group was 57 years, compared to 56 years in the non-screened (p=0.535). Among those who got screened, 68% (21) were males, and 32% (10) were females, compared to 35% (548) males and 65% (999) females in the non-screened group (p<0.001). Ninety-seven percent of the screened patients had anti-HCV antibody testing, and 3% had HCV RNA testing. Out of the 31 screened patients, four patients (13%) tested positive for HCV; these patients were referred to HCV specialists for further evaluation and treatment. Conclusion: Hepatitis C virus infection is the most common indication for liver transplantation in the United States, and is a leading cause of hepatocellular carcinoma. More than 3/4 of the newly diagnosed cases have been identified as baby boomers, verified by studies done by the CDC. The CDC has recently updated HCV screening guidelines to include patients who were born between 1945-1965, regardless of their risk factors. Our study shows the extremely low rates of HCV screening in the primary care setting. These findings support the need to increase awareness about hepatitis C screening. Adhering to these guidelines would result in early detection and referral of HCV positive patients for appropriate management. Future educational interventions should target both patients and primary care physicians, with frequent assessment and re-evaluation of these interventions.