Promoting notification and linkage of HBs antigen and anti-HCV antibody-positive patients through hospital alert system

Abstract

BackgroundIn Japan, approximately 0.9% and 1% of the whole population are infected with HBV and HCV, respectively. Doctors from departments other than gastroenterology often order viral hepatitis tests before an invasive examination or an operation. However, the notification of positive results to the patients and linkage to care is not appropriately performed. The in-hospital alert system was constructed to promote the notification and referral to gastroenterologists for patients with positive viral hepatitis tests, and its efficacy was evaluated.MethodsThe patients who tested HBsAg and anti-HCV antibody by chemiluminescent enzyme immunoassays and chemiluminescent immunoassays were investigated for whether they were notified of the positive results and if they were referred to gastroenterologists at our hospital. The notification and referral rate was compared before (from January to December 2014) and after the introduction of the alert system (from February to September 2016).ResultsHBsAg-positive rate was 1.1% (69/6543) before the introduction of the alert system and 0.8% (41/5403) after it. The notification rate has significantly improved from 46% to 73% (p = 0.0061) and the referral rate has improved from 16% to 27%, while not significant. Positive rate of anti-HCV antibody was 2.1% (139/6481) before the introduction of the alert system and 2.4% (128/5322) after it. The rate of notification and referral has significantly improved from 35% to 62% (p < 0.0001) and from 6% to 23% (p < 0.0001), respectively.ConclusionsThe in-hospital alert system increased the rates of notification and referral of the patients with positive viral hepatitis tests. Enlightenment of doctors other than gastroenterologists on viral hepatitis and cooperation of medical staffs would be helpful to improve the notification and referral rates.

Exploring the knowledge, attitudes and practices (KAP) of health care professionals on viral hepatitis notification in Gauteng, South Africa, 2015

“…An alert system seems pivotal to not only notify but also engage health care professionals and laboratories to link patients to care. In a study in Japan, an automated alert system improved notification from 46 to 73% and referrals from 16 to 27% in a hospital setting [ 22 ]. A study at Osaka City hospital, Japan, Fujii et al, [ 23 ] indicated that the use of “Private doctors’ practices” on electronic medical records significantly increased referrals of patients with Hepatitis B surface antigen (HBsAg) and HCV antibody positivity to hepatologists.…”

<p>Management of Hepatitis B Surface Antigen and Hepatitis C Antibody-Positive Patients by Departments Not Specializing in Hepatology at a Suburban University Hospital in Japan: A Single-Center Observational Study</p>

“…27,28 Introducing such a system may be expensive, and the resulting benefits associated with doing so may differ depending on the quality of it and the extent to which it operates, including the way it displays notifications and/or identifies relevant patients. [27][28][29] Such an alert system was introduced into the electronic medical chart network at our hospital in December 2019, which now notifies doctors of patients who require follow-up by hepatologists. The system automatically prints out the results of screening examinations in conjunction with a hard-copy document that doctors fill in.…”

“…An alert mechanism incorporated into electrical medical chart systems that informs doctors who are not hepatologists about the necessity of subsequent examinations and treatments in patients who tested positive for HBs-Ag or HCV-Ab may improve referral rates. 27 , 28 Introducing such a system may be expensive, and the resulting benefits associated with doing so may differ depending on the quality of it and the extent to which it operates, including the way it displays notifications and/or identifies relevant patients. 27 – 29 Such an alert system was introduced into the electronic medical chart network at our hospital in December 2019, which now notifies doctors of patients who require follow-up by hepatologists.…”

Screening, confirmation, and treatment rates of hepatitis C virus infection in a tertiary academic medical center in South Korea

“…Yoshioka et al . also reported significant improvements in the notification of patients (from 35% to 62%) and the patient referral rate (from 6% to 23%) using an in‐hospital alert system notifying positive anti‐HCV antibody test results to clinicians 31 . These automatic notification and patient referral systems might overcome the potential errors in notification and referral by forcibly checking the test results.…”