An electronic alert system increases screening for hepatitis B and C and improves management of patients with haematological disorders

Riveiro‐Barciela, Mar; Gubern, Paula; Roade, Luisa; Carreras, Maria Jose; Farriols, Anna; Bosch, Francesc; Esteban, Rafael; Buti, Marı́a

doi:10.1038/s41598-020-59476-4

Cited by 15 publications

(18 citation statements)

References 26 publications

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“… 18 A recent study from Spain also reported significant increase in HBV and HCV screening rates from 60.5% to 87.8% in 420 hematology patients after electronic alert system. 20 Our alert system also significantly increased HBsAg (from 55.1% to 93.1%) and anti-HBc IgG screening rates (from 4.3% to 79.4%) in patients receiving IST. However, our system had several important advantages over the previously defined ones.…”

Section: Discussionmentioning

confidence: 68%

“…Up to our knowledge, there are only a few studies about the use of electronic alert systems for increasing HBV screening rates before starting IST. 13 , 17 - 20 In a study from Spain, PRESCRIB project, an alert system increased HBsAg (from 47% to 94%) and anti-HBc IgG screening rates (from 29% to 85%) in patients receiving biologic agents. 17 In a Japanese study, HBView, an alert system increased anti-HBc IgG screening rates from 71% to 84% in patients receiving chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Electronic Alert System Significantly Increases HBV Screening Rates Before Immunosuppressive Treatments

Köksal¹,

Toka²,

Sadecolak³

et al. 2023

Turk J Gastroenterol

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Background: Hepatitis B Virus (HBV) screening rates before starting immunosuppressive treatments are suboptimal. The aim of the study was to evaluate the efficacy of a new electronic alert system in increasing HBV screening rates. Methods: The electronic alert system, HBVision2, identifies patients at risk of HBV reactivation when a pre-determined International Classification of Diseases (ICD)-10 code is entered into the hospital’s database or immunosuppressive treatment is prescribed. The system evaluates the prior Hepatitis B Surfage Antigen (HBsAg) and anti-Hepatitis B Core Immunglobulin G (HBc IgG) results and sends an alert code to the clinician for screening if serology is not completely available or consult a specialist in case of positive serology. The HBV screening and consultation rates of patients before (control group) and after HBVision2 were retrospectively compared. The clinical course of unscreened and/or unconsulted patients was determined, and the clinical efficacy of HBVision2 in preventing HBVr was predicted. Results: Control group included 815 patients (52.6% male, mean age: 60 ± 12, 82.5% with oncologic malignancy) and study group included 504 patients (56% male, mean age: 60 ± 13, 91.4% with oncologic malignancy). Groups were similar with respect to gender, mean age, and HBVr risk profile of the immunosuppressive treatment protocols. Overall, both HBsAg (from 55.1% to 93.1%) and anti-HBc IgG screening rates significantly increased (from 4.3% to 79.4%) after the electronic alert system ( P < .001, for both). Consultation rates of anti-HBc IgG-positive patients significantly increased from 40% to 72.7% ( P = .012). HBVr developed in 2 patients (2.6%) who were not screened and/or consulted after the alert system. Alert program prevented the development of HBVr in 10 patients (1.9%) of the study group and decreased the development of HBVr by 80%. Conclusion: Electronic alert system significantly improved HBsAg and anti-HBc IgG screening rates before starting immunosuppressive treatment and prevented the development of HBVr to a great extent. However, screening rates are still below optimal and need to be improved.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Electronic Alert System Significantly Increases HBV Screening Rates Before Immunosuppressive Treatments

Köksal¹,

Toka²,

Sadecolak³

et al. 2023

Turk J Gastroenterol

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“…We can also think that more awareness and education to clinicians about HBVr risk associated with chemotherapy could be necessary as many patients increased their hepatic enzymes during chemotherapy but the majority have not been tested for HBV. In other centers, strategies to promote and increase universal HBV screening and follow-up in cancer patients range from the use of computer alert programs [36][37][38][39] , electronic medical order check for anti-CD20 antibody treatment 40 or electronic alerts to monitor HBV-DNA every 3 months 41 . All those methods are considered imperfect and strategies need to be adapted to the local clinical environment.…”

Section: Discussionmentioning

confidence: 99%

Impact of universal hepatitis B virus (HBV) screening using chemotherapy orders on the HBV reactivation in cancer patients

Marty,

Adam,

Martel-Laferrière

et al. 2024

Preprint

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Introduction Hepatitis B virus (HBV) reactivation (HBVr) induced by chemotherapy in patients with resolved or chronic infection can lead to severe consequences. Despite recommendations, rates of HBV screening before chemotherapy are low due to poor recognition of risk factors by clinicians. The aim of the study is to assess whether routine HBV screening using universal HBV screening on chemotherapy orders (CO) could reduce HBVr incidence. Methods This is a one-year retrospective single-center observational study of patients who received intravenous chemotherapy post implementation of CO. We compared the incidence of HBVr in three groups of patients: those screened through CO (group 1), those screened by the medical team (group 2) and those not screened (group 3). Results On a total of 1374 patients, 179 of 206 patients were screened as requested on CO (group 1) and 421 by the medical team (group 2), whereas 747 patients were not screened (group 3). Only 1 HBVr occurred, and no difference was seen on the incidence of HBVr between group 1 and group 3 (0% vs 0.1%; p=1.00), probably because of a lack of follow‑up after chemotherapy. Follow‑up for HBVr was imperfect in group 1 and group 2 (16.7% vs 5.6%; p=0.32). Screening was done for 92% of patients on anti‑CD20 therapy. In group 3, 89 patients had ALT elevation during chemotherapy but only 17 (19%) were tested for HBVr. Conclusion Universal HBV screening on CO is useful to implement HBV detection and can help to prevent HBVr. Nevertheless, this screening method do not guarantee optimal follow‑up and requires improvements.

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“…Electronic reminder systems have been used for hepatitis screening for many years in many countries, including the United States, Japan, China, and Spain. The target populations for the implementation of the systems in clinical practice include baby boomers in the United States, for HCV screening, and patients with hematological disorders, outpatients, and inpatients at hospitals, for HBV and HCV screening [14][15][16]. In the United States, alert systems improved the screening rate from 10% to 64% [15].…”

Section: Discussionmentioning

confidence: 99%

Micro-Elimination of Hepatitis C among Patients with Kidney Disease by Using Electronic Reminder System—A Hospital-Based Experience

Hsu

et al. 2022

JCM

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Background: Little is known about the use of an electronic reminder system for HCV screening among patients with kidney disease. In this study, we tried to determine whether reminder systems could improve the HCV screening rate in patients with kidney disease. Methods: Patients with kidney disease were enrolled from August 2019 to December 2020 to automatically screen and order HCV antibody and RNA testing in outpatient departments. Results: A total of 19,316 outpatients with kidney disease were included, and the mean age was 66.5 years. The assessment rate of HCV antibody increased from 53.1% prior to the reminder system to 79.8% after the reminder system (p < 0.001), and the assessment rate of HCV RNA increased from 71% to 82.9%. The anti-HCV seropositivity rate decreased from 7.3% at baseline to 2.5% after the implementation of the reminder system (p < 0.001), and the percentage of patients with detectable HCV RNA among those with anti-HCV seropositivity decreased from 69.1% at baseline to 46.8% (p < 0.001). Conclusions: The feasibility of an electronic reminder system for HCV screening among patients with kidney disease in a hospital-based setting was demonstrated.

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An electronic alert system increases screening for hepatitis B and C and improves management of patients with haematological disorders

Cited by 15 publications

References 26 publications

Electronic Alert System Significantly Increases HBV Screening Rates Before Immunosuppressive Treatments

Electronic Alert System Significantly Increases HBV Screening Rates Before Immunosuppressive Treatments

Impact of universal hepatitis B virus (HBV) screening using chemotherapy orders on the HBV reactivation in cancer patients

Micro-Elimination of Hepatitis C among Patients with Kidney Disease by Using Electronic Reminder System—A Hospital-Based Experience

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