Date Available

4-24-2024

Year of Publication

2024

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Angela Grubbs

Clinical Mentor

Dr. Morgan Stacey

Committee Member

Dr. Jessica Sass

Abstract

Abstract

Background: In the United States, it is estimated that there are more than 2 million cases of Hepatitis C (HCV), with over 66,000 new cases since 2020 However, an estimated 75% of those with HCV go undiagnosed and less than 35% receive treatment within a year of diagnosis. In 2018, UK Healthcare (UKHC) implemented a universal HCV screening method using a Best Practice Advisory (BPA) for anyone 18 and older who presented to the Emergency Department and had labs ordered. Patients who screened positive were then referred to outpatient clinics for HCV treatment. Approximately ten percent of positive patients who were referred ultimately received treatment, and the average time from diagnosis to treatment exceeded 400 days . This led to the creation of an ED-based,pharmacy-driven, HCV linkage to care model where the pre-treatment work-up is off loaded from providers onto dedicated pharmacists through a collaborative care agreement. This model was very successful in the ED and is expected to be easily replicated in other healthcare settings including ambulatory care clinics at UKHC. With the rapid expansion, there was no information on baseline staff knowledge surrounding HCV screening and current treatment practices, and no education on the importance of using the universal BPA in an ambulatory care setting.

Purpose: The purpose of this quality improvement project was to expand and evaluate provider and clinical staff knowledge and screening practices surrounding universal opt-out HCV testing and linkage to care in ambulatory care settings and increase patient screening rates.

Methods: A quality improvement study using a quasi-experimental pre and posttest design was conducted with providers and clinical staff at two ambulatory care clinics at UKHC. A link that connected participants to a combined pretest, educational video and posttest on Qualtrics was sent out to all providers and staff using two separate list servs. A retrospective data collection was conducted 2 weeks following the completion of the survey.

Results: Of the 27 who opened the survey, 12 completed it. Participants were all female and predominantly MD, APRN, nurses and MAs. The responses revealed high knowledge and intentions to screen for HCV among providers and staff. However, data revealed only 4.86% of ambulatory patients were screened for HCV pre-intervention. Post-BPA screening rates increased to 8.3% with a relative change of 11.45% after the education. Provider likelihood to screen increased from a 75% likelihood to a 100% likelihood.

Conclusion: This project lays a solid foundation for future research and practice aimed at ensuring high rates of HCV screening and fostering positive health outcomes across diverse healthcare settings.

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