Outcomes of the implementation of the computer-assisted HBView system for the prevention of hepatitis B virus reactivation in chemotherapy patients: a retrospective analysis

Abstract

BackgroundScreening for hepatitis B virus (HBV) infection is recommended worldwide for patients receiving systemic chemotherapy in accordance with clinical guidelines, but compliance varies by country and facility. Alert systems may be useful for promoting screening, but it is unclear how effective such systems are. In this study, we investigated HBV screening procedures and their incorporation into treatment regimens following the implementation of an alert system.MethodsAn alert system was introduced at our hospital in April 2012. The rates of HBV screening in the periods before and after the introduction of the alert system (September 2010 to March 2012 and April 2012 to October 2013, respectively) were investigated. We collected data on hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb), and HBV-DNA testing in patients. As a result of this analysis, we developed a system in which pharmacists would intervene to check and confirm whether HBV screening had occurred in patients scheduled to begin treatment with chemotherapy. We named our project the “HBView” project, and the rate of HBV screening and the number of times pharmacists intervened was studied during specific time periods before and after the HBView project commenced (July 2013 to December 2013 and January 2014 to June 2014, respectively).ResultsAfter introducing the alert system, the percentage of patients tested for HBsAb/HBcAb and HBV-DNA increased significantly, from 71.6 % to 84.9 % and from 44.5 % to 69.7 %, respectively. However, the rate of compliance with HBV testing guidelines was not 100 % after interventions. The numbers of patients who were not screened but should have been before and after the introduction of HBView were 6 and 17, respectively. Two patients at risk of HBV reactivation were identified after intervention by pharmacists; their intervention thus prevented HBV reactivation.ConclusionsCompliance with clinical HBV screening guidelines was not sufficiently improved after the introduction of the automatic alert system; however, the HBView project proved useful in reinforcing the automatic alert system.

Management of hepatitis B reactivation in lymphoma patients on rituximab with past hepatitis B exposure: An observational study

“…positive HBV DNA, which may warrant prompt anti-viral prophylaxis to start with, 16,18,20 as further emphasized by Hwang et al 25 This highlights gaps in HBV screening, suggesting the potential utility of a computer-assisted alert system in aiding to ensure standardized and complete HBV screening prior to rituximab initiation. 26 After rituximab initiation, approximately 40% of patients did not have HBV DNA tests performed during treatment, at initial six month follow-up, and at subsequent follow-ups. As the onset of HBV reactivation is uncertain, current guidelines suggest HBV DNA testing one to three monthly.…”

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

“…Alert systems focusing on HBV have been described previously 7,12 . In the present study, addition of HCV to the test panel in our EAS was also found to be useful for diagnosing new cases of chronic hepatitis C, which led to the start of treatment with direct-acting antiviral agents and sustained virological response.…”

“…Hence, testing for viral hepatitis markers before starting these drugs is vital to identify patients at risk of HBV reactivation, who may be candidates for antiviral prophylaxis. In this regard, the use of alert systems has been explored to improve screening rates 7,12 . Sampedro et al reported that use of a computerized physician order entry-based system for patients treated with biologic agents led to a screening rate for HBV markers greater than 85% 7 , a value comparable to the overall percentage of testing in our cohort after the EAS alerts.…”

Impact of the timing of hepatitis B virus identification and anti–hepatitis B virus therapy initiation on the risk of adverse liver outcomes for patients receiving cancer therapy

“…16,17 Future efforts should focus on the risk of HBV reactivation and optimal strategies for HBV screening and prophylactic antiviral in solid tumor patients.…”

“…Alerts in electronic health systems could facilitate HBV screening and early anti-HBV therapy. 16,17 Future efforts should focus on the risk of HBV reactivation and optimal strategies for HBV screening and prophylactic antivirals in patients with solid tumors.…”