Treatment of Hepatitis C Infection in an Internal Medicine Residency Continuity Clinic: Resident Perspectives and Patient Outcomes.

Introduction: Studies have demonstrated that primary care clinicians can achieve the same excellent outcomes in treatment of hepatitis C (HCV) infection as specialist physicians but there is a dearth of literature on experiences and outcomes of treatment of HCV infection in residency clinics. We sought to describe the perspectives of internal medicine resident physicians in one community-based residency program toward treating HCV infection before and after launching treatment of HCV infection within the residency clinic. Further, this study examined outcomes of patients treated by the resident physicians. Methods: Treatment of HCV infection was initiated in 2019. Residents were invited to complete a baseline survey. Residents who treated at least one patient with HCV infection were invited to complete a subsequent survey. Comparative analysis was performed using Fisher's Exact test. Sustained virologic response at least 12 weeks (SVR-12) after completion of treatment in patients initiated on therapy in the residency clinic was assessed. Results: Residents (n = 12) who treated patients for HCV infection reported significantly greater knowledge in evaluating and treating patients with HCV infection and preparedness to provide this care after residency than residents (n = 34) who completed the baseline survey (p < 0.001). Twenty-six patients were initiated on direct-acting antiviral (DAA) therapy. All 21 patients who were tested achieved SVR-12. Conclusions: Training resident physicians to evaluate and treat HCV infection can improve outcomes for underserved patients in residency clinics while preparing a pool of physicians to provide this care after residency.

Impact of a Process Change on Prevalence of Prescribed Unmeasurable Liquid Doses in a Neonatal Intensive Care Unit.

OBJECTIVES: Most prescribing through the electronic health record (EHR) in the NICU at St. Vincent Women's Hospital use a weight-based dosing calculator. Prescribers receive no alert if the resulting volume is unmeasurable. Study definition of measurable was a dose volume with a visible hash mark on an appropriately sized oral syringe. The primary objective was to compare the rate of unmeasurable oral liquid doses prescribed at discharge before and after implementation of educational process changes. Secondary objectives assessed patient and discharge medication characteristics in relation to the unmeasurable doses prescribed. METHODS: This study was a 2-phase retrospective analysis of patients discharged from the NICU between January 1 and June 30, 2016 (phase I), and between October 1, 2017, and March 31, 2018 (phase II). Patients were included in the analysis if they were discharged on at least 1 oral liquid medication, excluding vitamins. Demographic and discharge medication information was collected. RESULTS: There were 58 patients discharged on a total of 118 oral liquid medications in phase I and 63 patients discharged on a total of 111 oral liquid medications in phase II. Following implementation of the process change, the percentage of unmeasurable discharge prescriptions decreased from 27 (23%) to 5 (4.5%) (p < 0.001). CONCLUSIONS: The educational process change implemented in the NICU effectively reduced the rate of unmeasurable doses prescribed at discharge from 1 in 4 to 1 in 25. Additional system-level changes may result in further reductions.