Identifying and Fixing Roadblocks to Hepatitis C Screening in the Primary Care Setting

Abstract

Introduction: Hepatitis C (HCV) infection is estimated to affect >5 million people in the United States, but >60% are unaware of their infection. With more effective curative therapies expected in the next year, identifying patients with HCV will be of significant importance. In 2012, the CDC, with support from the USPSTF, released guidelines recommending one-time screening for HCV in all people born between 1945 and 1965 (age-cohort screening). We sought to quantify the screening rate in a resident-run university-based primary care setting after release of these guidelines and identify barriers to screening. Methods: A retrospective chart review was performed of all patients born from 1945-1965 seen at a tertiary care teaching clinic during a 3-month period. Patients who had a known diagnosis of HCV or had previously been screened were excluded from further analysis, and remaining patients were assessed for screening rates as well as risk factors for HCV infection. After completion of the chart review, an online questionnaire was sent to the resident providers to assess self-reported HCV screening rates as well as reasons for not performing screening. Results: Three hundred ninety-five eligible visits comprising 314 unique patients occurred during the 3-month study period. Of those, 115 (37%) had been previously screened for HCV. Of the remaining 199 patients, only 6 (3%) were screened during the study period. Of these 6 patients, 4 were actually tested for HCV for other reasons (2 IV drug users, 2 with elevated LFT’s). Forty-five resident physicians responded to the questionnaire regarding their HCV screening practices. The self-reported screening rate for HCV was 22%; 7X higher than actually observed. The reasons most commonly cited for lack of screening were provider unawareness of screening guidelines (54%), and medically complex patients leaving inadequate time for preventative screening (51%). Conclusion: Despite the new CDC guidelines for screening HCV based on age-cohort (those born between 1945 and 1965), this single-center study demonstrates that HCV screening remains extremely suboptimal in primary care teaching clinics. Only 3% of eligible patients were tested; mostly due to risk factors or elevated LFT’s rather than age-cohort screening. The main barriers to screening appear to be lack of knowledge of the new screening guidelines as well as limited time to care for complex medical patients. With these issues in mind, additional components of this project will be to implement teaching and outreach programs for the healthcare providers and then reassess screening rates after intervention. If this program is successful in increasing screening rates, it will be implemented across our entire healthcare system.