Provider and Staff Education Surrounding Universal HCV Screening and Linkage to Care in an Ambulatory Care Setting

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

Health Needs Assessment of People with Disabilities in Massachusetts, 2013

The Disability, Health and Employment Policy Unit at UMass Medical School conducted an assessment of the health needs of people with disabilities on behalf of the Health and Disability Program (HDP), Office of Health Equity, Massachusetts Department of Public Health. The assessment was conducted to meet the Centers for Disease Control and Prevention (CDC) funding requirements of the Health and Disability Program and provided an in-depth examination of the health needs of people with disabilities in Massachusetts. This assessment provides comprehensive information on the unmet public health needs and priorities of the disability community in Massachusetts to enable HDP to prioritize its programmatic goals and objectives and better understand and meet the needs of Massachusetts residents with disabilities. A multi-prong approach was used to collect data for this needs assessment. The sources of data include: (1) an existing health survey of adults in Massachusetts, (2) an online community survey of the health needs of people with disabilities in Massachusetts, and (3) interviews with key informants from the Massachusetts disability community

Use of a reference text by pharmacists, intern pharmacists and pharmacy students: a national cross-sectional survey

Background: Reference texts assist pharmacists by addressing knowledge gaps and enabling evidence-based decisions when providing patient care. It is unknown whether reference text utilisation patterns differ between pharmacists, intern pharmacists and pharmacy students. To describe and compare the self-reported use and perceptions of a reference text, namely the national formulary, by pharmacists, intern pharmacists and pharmacy students. // Methods: Registered pharmacists, intern pharmacists and pharmacy students living in Australia were surveyed in July 2020. The survey was electronic and self-administered. Questions considered self-reported use of a specific reference text in the preceding 12 months. // Key findings: There were 554 eligible responses out of 774 who commenced the survey: 430 (78%) pharmacists, 45 (8%) intern pharmacists and 79 (14%) pharmacy students. Most participants (529/554, 96%) reported historical use of the text, though pharmacists were significantly less likely than intern pharmacists and students to use it frequently (52/422, 12% versus 16/43, 37% versus 23/76, 30%, P < 0.001). Pharmacists (44%, 177/404) reported using the text as a tool to resolve a situation when providing a service or patient care (177/404, 44%) or as a teaching resource (150/404, 38%). In contrast, intern pharmacists and students most commonly use these to familiarise themselves with the contents (30/43, 70%; 46/76, 61%) or update their knowledge (34/43, 79%; 53/76, 70%). // Conclusions: Access and use patterns varied significantly across career stages. A broader understanding of the use of reference texts may help develop interventions to optimise the content and usability. Varying usage patterns across the groups may inform the tailoring of texts for future use

Implementing a novel remote physician treatment coverage practice for adaptive radiation therapy during the coronavirus pandemic

Purpose: The 2019 coronavirus disease pandemic has placed an increased importance on physical distancing to minimize the risk of transmission in radiation oncology departments. The pandemic has also increased the use of hypofractionated treatment schedules where magnetic resonance-guided online adaptive radiation therapy (ART) can aid in dose escalation. This specialized technique requires increased staffing in close proximity, and thus the need for novel coverage practices to increase physical distancing while still providing specialty care. Methods and Materials: A remote-physician ART coverage practice was developed and described using commercially available software products. Our remote-physician coverage practice provided control to the physician to contour and review of the images and plans. The time from completion of image registration to the beginning of treatment was recorded for 20 fractions before remote-physician ART coverage and 14 fractions after implementation of remote-physician ART coverage. Visual quality was calculated using cross-correlation between the treatment delivery and remote-physician computer screens. Results: For the 14 fractions after implementation, the average time from image registration to the beginning of treatment was 24.9 ± 6.1 minutes. In comparison, the 20 fractions analyzed without remote coverage had an average time of 29.2 ± 9.8 minutes. The correlation between the console and remote-physician screens was Conclusions: Our novel remote-physician ART coverage practice is secure, interactive, timely, and of high visual quality. When using remote physicians for ART, our department was able to increase physical distancing to lower the risk of virus transmission while providing specialty care to patients in need