Improving the Screening and Treatment of Hepatitis C in a Rural Primary Care Clinic.

Abstract

Background and objectives: With the potential to lead to liver failure, cirrhosis, and death and the availability of hepatitis C Virus (HCV) treatment with direct-acting antiviral medications, primary care clinicians need to take action to improve screening and treatment of HCV. Current literature demonstrates gaps in knowledge contribute to low HCV screening and treatment rates. The project's purpose is to use a multidisciplinary approach to patient and clinician education to improve HCV care in a rural primary care clinic.

Methods: This quality improvement project involved 1225 adult patients aged 18-79 seen at a rural Federally Qualified Health Center (FQHC) in Arkansas, from February 15 to April 1, 2024. The project applied the Chronic Care Model to promote change in decision support and clinical information systems by educating patients and clinicians, reinforcing care accuracy, and monitoring practice. Project interventions included provider, clinical staff, and patient education and improving the visibility of the patient's HCV screening status in the electronic medical record (EMR). The clinic manager and marketing director assisted the project leader with educational training. The laboratory director designated an area for HCV screening history in the EMR, and the quality director evaluated the program's efficacy. A manual retrospective chart review was performed to evaluate the program's effectiveness. The collected data were analyzed using descriptive statistics to demonstrate the efficacy of the quality improvement project.

Results: Following the implementation of this project, providers at the clinic demonstrated an improved understanding of current HCV screening and treatment guidelines. Additionally, the HCV screening rates for eligible adults increased from the baseline screening rate of 42% to 44.8% with 549 of 1225 eligible patients screened for HCV during the project implementation period. Additionally, 100% (n = 4) of adult patients diagnosed with HCV from February 15, 2024, to April 1, 2024, initiated HCV treatment ordered by their primary care provider.

Conclusions: While the short duration of the project poses a limitation, implications from this project to current practice point to the importance of innovative changes in information technologies as well as patient, staff, and clinician education to improve access to HCV screening and care in rural primary care clinics. Further, to improve the quality of care and the screening and treatment of HCV, rural health clinics and organizations should consider updating policies and procedures to standardize HCV screening for adults aged 18-79.