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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3014 — The Liver Health Initiative: Offering Hepatitis Prevention Services during Substance Abuse Treatment

Author List:
Hagedorn HJ (Substance Use Disorders QUERI, Minneapolis VA Medical Center, University of Minnesota)
Willenbring M (National Institute on Alcohol Abuse and Alcoholism)
Dieperink E (Hepatitis C Resource Center, Minneapolis VA Medical Center, University of Minnesota)
Pexa N (Substance Use Disorders QUERI, Minneapolis VA Medical Center)
Dingmann D (Minneapolis VA Medical Center)
Durfee J (Hepatitis C Resource Center, Minneapolis VA Medical Center, University of Minnesota)
Ho S (Hepatitis C Resource Center, Minneapolis VA Medical Center, University of Minnesota)

Objectives:
The purpose of the Liver Health Initiative was to develop a program for: 1) improving testing for hepatitis A, B, and C infection and immunity, 2) providing comprehensive patient education on liver health, 3) beginning a hepatitis A and B immunization program, and 4) increasing rates of successful referral to the hepatitis clinic for hepatitis C positive patients within the Addictive Disorders Service (ADS) at the Minneapolis VA Medical Center.

Methods:
A chart audit of 104 consecutive ADS intakes was completed to determine baseline rates of screening, feedback, and referral for hepatitis infections. In July 2004, a stakeholder group was convened to meet weekly to develop service improvement goals and procedures. In January 2005, a “Healthy Liver” program was launched. A chart audit of 106 consecutive ADS intakes was completed in June 2005 to evaluate the effectiveness of the program.

Results:
Testing for hepatitis C infection was high at baseline (72.1%) and improved to 77.4% at follow-up. Testing for hepatitis A and B immunity was low at baseline (<20%) and improved to 74.5% at follow-up. Of patients scheduled into a hepatitis education and screening feedback group, 77.5% (31/40) attended. 87.1% (27/31) followed the treating nurse’s recommendation to start a vaccination series for hepatitis A and/or B. 92.6% returned for their first booster shot. Feedback and referral for patients testing positive for hepatitis C improved only slightly from 44% to 50%.

Implications:
Screening, education, and vaccinations for hepatitis infections can be successfully integrated into VA substance use disorders clinics. High patient interest in these services is evidenced by the high attendance rate and the high acceptance of vaccine recommendations. Ongoing evaluation of the implementation effort has assisted the stakeholder group in identifying areas for further improvement (e.g., feedback and referral rate for hepatitis C positive patients).

Impacts:
Experience from this pilot will be used to promote implementation of liver health programs in additional VA substance use disorders clinics. The ultimate goal of the Liver Health Initiative is to reduce rates of new hepatitis infections and improve identification and treatment of existing infections among veterans seeking treatment for substance use disorders.


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