Technology meets time: assessing the impact of clinical decision support tools for viral hepatitis in primary care (the HepLOGIC pilot and feasibility study)

Abstract

Lack of diagnosis and management of hepatitis B and C in Australia contribute to the increasing burden of liver cancer and other adverse outcomes for those affected. The Hep atitis and l iver cancer o utcomes in g eneral practice: an i ntervention c ollaboration (HepLOGIC) study evaluated a point-of-care (POC) tool and an audit tool as an intervention to improve guideline-based hepatitis B and C testing and management in primary care. We evaluated the HepLOGIC intervention using the RE-AIM framework, assessing R each, E ffectiveness, A doption, I mplementation, and M aintenance. A mixed methods evaluation included quantitative assessment of user metrics such as logins and testing and management outcomes between tool users and non-users, as well as qualitative feedback gathered from surveys with clinicians and practice managers. Sixteen practices completed participation in the study, collectively seeing 119,613 patients during the intervention period. Of these 16.5% were indicated for hepatitis B testing and 10.3% for hepatitis C testing. Adoption of the POC tool was highly variable between practices, limiting its reach and effectiveness. The tool was only active (installed and logged in) for 20.9% of presenting patients indicated for hepatitis B testing and 22.3% for hepatitis C testing. Uptake of testing was higher when the POC tool was in use than when it was not; however, it was low in both groups (6.7% vs. 4.3% for hepatitis B and 6.7% vs. 4.6% for hepatitis C, p < 0.001 for both comparisons). Low patient numbers limited evaluation of the POC tool for improving hepatitis management. Practices provided positive feedback on the intervention but reported barriers to adoption, including login requirements, limited clinician engagement, and competing time demands. The audit tool was reported as preferred for incorporating into workflows in most practices. However, no practices employed the tool for broad patient recalls during the study, citing capacity constraints to undertake such activities. While implementation of this intervention was feasible and supported in principle by clinicians, numerous factors limited its adoption, reach and maintenance, and therefore its effectiveness. Alternative strategies are required to achieve necessary improvements in uptake of testing and management for hepatitis B and C in primary care.