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GPs increase hepatitis C diagnoses in first clinical trial of computer algorithm

GPs have given their approval to an electronic hepatitis C testing initiative, which uses an algorithm to flag patients potentially at risk of the disease.

Around 143,000 people in the UK have chronic HCV infection and GPs were told last year by NHS England that they should do more testing to identify patients affected by the disease.

The Hepatitis C Assessment to Treatment Trial (HepCATT), led by the University of Bristol, is the first UK clinical trial of a scheme showing an increase in the identification and treatment of the condition in patients in primary care,

Five times more patients were assessed for treatment under the scheme compared with control cases, according to the study findings, published in the BMJ.

The trial, funded by the National Institute for Health Research, assessed whether a multi-part intervention in GP practices could increase the identification and treatment of HCV-infected patients compared with usual care. It took place in South West England, with 22 practices randomised to intervention and 23 to the control arm.

An electronic algorithm was devised to flag patients with HCV risk markers and invite them for an HCV test by letter, or through pop-up messages during consultations. Practice staff received HCV educational training, and HCV posters and leaflets were placed in waiting rooms to increase patient awareness.

Around 5% of all patients were flagged with HCV risk markers; and 16% of the flagged patients were tested for HCV in HepCATT intervention practices compared to 10% in control practices – a 59% increase after adjusting for the characteristics of different practices.

The intervention was comparatively low cost at an average of £624 per general practice and £3,165 per additional patient assessed at hepatology.

GPs participating in the study said the algorithm provided them with a list of patients with HCV infection risk factors that they were not aware should be targeted for testing.

They also said they appreciated the opportunity to discuss testing with patients – especially those who may not have been aware of their HCV risk. The  study found the training enhanced GPs’ HCV awareness and knowledge of risk factors, which itself acted as a prompt for opportunistic testing.

Professor Graham Foster from Queen Mary’s University London and clinical lead for hepatology at Barts Health, said: ‘Our primary care colleagues are key partners in the campaign and HepCATT provides the essential evidence base to allow us to expand testing into primary care in an affordable, cost-effective manner.’

Dr Jeremy Horwood, associate professor of social sciences and health at the Centre for Academic Primary Care at the University of Bristol and ARC West, who led the qualitative evaluation, said: ‘With adequate resources and technology, primary care can play an important role in identifying patients with hepatitis C infection who have the potential to benefit from treatment.

‘The cost-effective HepCATT intervention provides primary care with a range of tools to improve identification and care for HCV-infected patients and prevent HCV-related illness..’