Computerized System Keeps Hepatitis Patients on Track

With one of the highest numbers of hepatitis C patients in the national VA network, the Houston VA Medical Center’s hepatitis clinic is taking steps to make sure veterans know about risk factors and how to get screened and tested at VA facillities.

Late last year, the Houston VA Medical Center’s Primecare Clinic, in conjunction with the hepatitis C clinic, established an automatic, computerized clinical reminder program that prompts the patients’ Primecare provider to ask for hepatitis C risk factors when the system detects patients who have not been tested. If a risk factor is identified, the provider can then order a screening test. If the test is positive, software prompts the health care provider to order a confirmatory test and/or send an automatic consult to the hepatitis C clinic. If a positive test is confirmed, the provider is prompted to send a consult to the hepatitis C clinic. The program recycles high-risk patients automatically every two years.

The Houston VA Medical Center has treated more than 330 veterans for hepatitis C in the last four years. Last year, the number of treated patients increased by more than 50 percent. More than 500 veterans to date have received vaccination against hepatitis A and/or B in the hospital’s hepatitis C clinic. Each patient who is seen in the clinic is fully evaluated, and vaccinations are administered accordingly.

"In a short time, VA has established the largest screening and testing program for hepatitis C infection in the world," said Secretary of Veterans Affairs Anthony J. Principi. "Hepatitis C testing, treatment and research are among VA’s highest health priorities."

Hepatitis C is a virus that infects the liver, causing tissue damage and in some cases, permanent liver problems, including cirrhosis (scarring) and liver failure. Testing has only been available since 1992, and the disease is a leading reason for liver transplantation.

"The Houston VA Medical Center has taken a vigorous, aggressive approach to this relatively new disease," said Thomas Horvath, M.D., Houston VA Medical Center chief of staff. "In September 2000, we established a hepatitis C clinic staffed by an infectious disease specialist and a nurse who devotes 24 hours each week to the care of hepatitis C patients. This clinic is in addition to physicians in our GI department who are also treating patients with hepatitis C."

The VA has screened more than 1.7 million veterans for hepatitis C risk factors and each year cares for more than 70,000 veterans with the disease. Coordinated services provide state-of-the-art care, ranging from risk factor identification counseling and disease prevention, to providing medication and health care, including liver transplantation.

"We are managing hepatitis C infection through a comprehensive approach to prevent disease transmission and long-term complications," added Horvath. "This is a model for how other large systems can manage this serious disease."

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©2006 Texas Medical Center

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