Room for Improvement: Rates of Birth Cohort Hepatitis C Screening in Primary Care Practices-A WWAMI Region Practice and Research Network Study.

Introduction: An estimated 2.4 million people in the United States live with hepatitis C. Though there are effective treatments for chronic hepatitis C, many infected individuals remain untreated because 40% to 50% of individuals with chronic hepatitis C are unaware of their hepatitis C status. In 2013, the United States Preventive Services Task Force (USPSTF) recommended that adults born between 1945 and 1965 should be offered one-time hepatitis C screening. The purpose of this study is to describe rates of birth cohort hepatitis C screening across primary care practices in the WWAMI region Practice and Research Network (WPRN). Methods: Cross-sectional observational study of adult patients born between 1945 and 1965 who also had a primary care visit at 1 of 9 participating health systems (22 primary care clinics) between July 31, 2013 and September 30, 2015. Data extracted from the electronic health record systems at each clinic were used to calculate the proportion of birth cohort eligible patients with evidence of hepatitis C screening as well as proportions of screened patients with positive hepatitis C screening test results. Results: Of the 32 139 eligible patients, only 10.9% had evidence of hepatitis C screening in the electronic health record data (range 1.2%-49.1% across organizations). Among the 4 WPRN sites that were able to report data by race and ethnicity, the rate of hepatitis C screening was higher among African Americans (39.9%) and American Indians/Alaska Natives (23.2%) compared with Caucasians (10.7%; P < .001). Discussion: Rates of birth cohort hepatitis C screening are low in primary care practices. Future research to develop and test interventions to increase rates of birth cohort hepatitis C screening in primary care settings are needed.

Ethical issues facing providers in collaborative primary care settings: do current guidelines suffice to guide the future of team based primary care?

This special issue discusses the ethical issues providers face in collaborative primary care settings. It is organized in three sections: (a) Common Themes, (b) Context-Specific Quandaries, and (c) Research and Training. It provides case examples to illustrate ethical dilemmas, describe professional ethical standards pertinent to the case, identifies gaps in available guidance and how guidelines might be elucidated in state statues (without going into detail about specific states), offers feasible recommendations to BHCs for deciding an ethical course when extant guidance was lacking, and then demonstrates and applies the recommendations to achieve an ethical resolution to the case example.

Primary care provider reflections on common themes from special issue on ethical quandaries when delivering integrated primary care.

Comments on the articles by Hudgins, Rose, Fifield, & Arnault, (see record 2013-11498-002), Reiter & Runyan, (see record 2013-11498-003), Hodgson, Mendenhall, & Lamson (see record 2013-11498-004), and Kanzler, Goodie, Hunter, Glotfelter, & Bodart (see record 2013-11498-005), regarding the topic of common themes for the special issue on ethical quandaries when delivering integrated primary care. The current author provides brief reflections on each article.

Primary care provider reflections on context-specific quandaries from special issue on ethical quandaries when delivering integrated primary care.

Comments on the articles by Robinson & Rickard, (see record 2013-11498-007), Dobmeyer, (see record 2013-11498-008), Mullin & Stenger (see record 2013-11498-009), and Rosenberg & Speice (see record 2013-11498-010) regarding the topic of context-specific quandaries for the special issue on ethical quandaries when delivering integrated primary care. The current author provides brief reflections on each article.

Primary-care provider reflections on research and training from special issue on ethical quandaries when delivering integrated primary care.

Comments on the articles by Goodie, Kanzler, Hunter, Glotfelter, & Bodart, (see record 2013-11498-012), and Reitz, Simmons, Runyan, Hodgson, & Carter-Henry(see record 2013-11498-013), regarding the topic of research and trainng for the special issue on ethical quandaries when delivering integrated primary care. The current author provides brief reflections on each article.

Contraceptive methods and informed consent among women receiving medications with potential for adverse fetal effects: a Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) region study.

BACKGROUND: Increasing diabetes, hypertension, and hypercholesterolemia rates expose some young women to medications with potential adverse fetal effects, such as angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and statins. This study examined whether quality improvement (QI) interventions promote informed consent and contraception to minimize risks with use of ACE-I/ARB/statins. METHODS: This longitudinal cohort study at 7 clinics abstracted medical records of 328 women aged 18 to 44 with ≥1 prescription for ACE-I/ARB/statins and ≥1 visit for hypertension, diabetes, or hypercholesterolemia during the previous year. We measured informed consent documentation and contraceptive methods before and after QI interventions in which providers contacted their patients to discuss medication risks and benefits. RESULTS: Of 179 women who were not surgically sterilized, only 11.7% had documented informed consent related to the risks of ACE-I/ARB/statin use. One hundred fifty-eight women were eligible for the QI intervention (not surgically sterilized, no documented informed consent); only 76 (48.1%) received the intervention. Before the intervention, 23.7% of these 76 were "at risk" of an adverse fetal effect. After the intervention, only 7.9% (P ≤ .001) were "at risk" because some women started contraception, discontinued ACE-I/ARB/statins, or changed drug class. CONCLUSIONS: Women prescribed ACE-I/ARB/statins were not consistently using contraception or were not consistently informed of the risks. Provider-implemented QI interventions improved care but were difficult to accomplish, suggesting that new interventions are needed.