Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
The risk of viral hepatitis reactivation in patients undergoing immunomodulating therapy is being increasingly recognized. The American College of Rheumatology guidelines recommends screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections prior to initiation of Methotrexate (Arthritis Rheum. 2003; 49: 843–845; Arthritis Rheum. 2008; 59: 762–784). In this Quality Improvement (QI) study, we evaluated screening practices at the Veterans Affairs (VA) Medical Center in Syracuse, New York.
Methods:
To perform quality assessment as the first step of the Plan-Do-Study-Act QI methodology (BMJ Qual Saf.2014; 23:290–8), we extracted records of 299 patients receiving methotrexate for rheumatologic diseases at the Syracuse VA between 2011-2016. The patient records were then retrospectively examined to assess if they had undergone screening for HBV and HCV infections prior to initiation of methotrexate. The inclusion criteria were defined as: 1) age > 30 years; 2) initiation of methotrexate within the 5 years preceding the study period; and 3) methotrexate dosages < 30 mg per week. Compliance rate from the current study at the Syracuse VA was compared to two previously published studies with chi-square test using GraphPad software (San Diego, CA). Two-tailed p <0.05 was considered significant.
Results:
From a total of 299 patients treated with methotrexate at the Syracuse VA, only 104 (34%) were screened for both HBV and HCV infections prior to therapy initiation. In comparison to peer-reviewed literature, there was considerable variability in screening rates.
Table 1: HBV and HCV screening at the Syracuse VA and its comparison to the literature.
|
Study |
Tested |
Not tested |
Compliance |
Chi-square p |
|||||
|
Syracuse VA |
104 |
195 |
34.7% |
– |
|||||
|
Clin Rheumatol 2014; 33: 1823 |
6 |
79 |
7% |
< 0.0001 |
|||||
|
Clin Exp Rheumatol. 2016; 34:473-9 |
861 |
475 |
64.4% |
< 0.0001 |
|||||
Conclusion:
Our study clearly indicates that QI aimed at increasing compliance with ACR guidelines among rheumatologists regarding the risks of viral hepatitis reactivation in patients treated with immunosuppressant medications is warranted. We propose a QI initiative that testing for HBV and HCV should be prompted when electronically ordering methotrexate in patients with rheumatic diseases.
To cite this abstract in AMA style:
Jaffari F, Perl A, Allam F. Rheumatologists’ Compliance with Screening for Viral Hepatitis B and C Prior to Initiation of Methotrexate Treatment Needs Quality Improvement [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/rheumatologists-compliance-with-screening-for-viral-hepatitis-b-and-c-prior-to-initiation-of-methotrexate-treatment-needs-quality-improvement/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatologists-compliance-with-screening-for-viral-hepatitis-b-and-c-prior-to-initiation-of-methotrexate-treatment-needs-quality-improvement/