Implementation of a Best Practice Advisory to Improve Infection Screening Prior to New Prescriptions of Biologics and Targeted Synthetic Drugs.

Abstract

Use of biologic and targeted synthetic DMARDs (b/tsDMARDs) in patients with pre-existing tuberculosis (TB), hepatitis B virus (HBV), or hepatitis C virus (HCV) infection can have serious consequences. Although various society guidelines recommend routine screening for these infections prior to initiating certain b/tsDMARDs adherence to these recommendations varies widely. This quality improvement initiative evaluated local compliance with screening and assessed if automated computerized decision support system (CDSS) in the form of a best practice advisory (BPA) in the electronic health record could improve patient screening. Established patients with autoimmune rheumatic disease (ARD) aged 18 years or older with at least one visit to our rheumatology practice between 10/1/2017 and 3/3/2022 were included. When prescribing a new b/tsDMARD, clinicians were alerted via a BPA that showed the most recent results for TB, HBV, and HCV. Screening proportions for TB, HBV, and HCV before BPA initiation were compared with those of eligible patients after the BPA implementation. A total of 711 patients pre-BPA and 257 patients post-BPA implementation were included in the study. The BPA implementation was associated with statistically significant improvement in screening for TB from 66% to 82% (p=<0.001), HCV from 60 to 79% (p=<0.001), hepatitis B core antibody (HBcAb) 32% to 51% (p=<0.001), and hepatitis B surface antigen (HBsAg) from 51% to 70% (p=<0.001). Implementation of a BPA can improve infectious disease screening for patients with ARD who are started on b/tsDMARD and has potential to improve patient safety. This article is protected by copyright. All rights reserved.