Non-adherence to HCV Screening Among Persons Born Between 1945-1965: Family Medicine Versus Internal Medicine

Abstract

Introduction: In August 2012, The Centers for Disease Control and Prevention (CDC) recommended a 1-time testing for hepatitis C virus (HCV) among persons born between 1945-1965 regardless of their prior risk factors. However, screening for HCV in primary care physician (PCP) clinics has been suboptimal nationally and a large number of patients remains unscreened. PCPs usually complete training in internal medicine (IM) or family medicine (FM). We aim to compare the current screening practice for HCV between FM and IM PCPs according to the new CDC guidelines. Methods: We retrospectively reviewed the charts of all patients born between 1945-1965 who visited an IM or FM clinic in August-September 2013. Data collected included: year of birth, gender, race and HCV testing (By antibody and/or HCV RNA) at any point of time from the first clinic visit through 12/31/2014. Liver function tests (LFTs) were recorded for those who were evaluated for HCV at the time of testing. Results: A total of 1085 charts were reviewed (52.1% in FM, and 47.9% in IM). Overall, more patients were not screened for HCV in the IM group compared the FM group (82.3% vs. 74.3%, p < 0.001). Majority of the patients evaluated for HCV in the FM clinic (88, 60.7%) were tested before the new CDC guidelines were released while most of the patients evaluated for HCV (56, 60.9%) in the IM clinic were tested after the guidelines were released in August 2012 (p=0.001). Compared to IM, FM patients were older, mostly whites, more likely to be females and had a shorter duration of follow-up from their first clinic visit. There was no significant difference in the LFTs results between the two tested groups.Figure 1Conclusion: Under screening for HCV among persons born between 1945-1965 is high in both family medicine and internal medicine practices after a year from the release of the new CDC guidelines. In this study, internal medicine providers are increasingly testing for HCV and might be slowly adhering to the new HCV screening guidelines. However, it is still possible that both disciplines are testing for HCV based on risk factors or to evaluate elevated LFTs. In any case, primary care providers need more education to increase HCV screening and diagnosis at an early stage.