Using an electronic health record alert to prompt blood-borne virus testing in primary care

Background: Late diagnosis of HIV, hepatitis B (HBV) and hepatitis C (HCV) remains relatively common in the UK and many people who present late have missed opportunities for testing in primary care. The objective was to assess the effectiveness and acceptance of a prototype application (BBV_TP1), embedded in a primary care electronic health record (EHR), to increase real-time blood-borne virus (BBV) testing. Methods: This prospective cohort study assessed BBV_TP1 in 14 general practices in North East England, in comparison with 54 similar practices in 2019. Rates of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) testing in practices were measured before and after the application was activated. Patient and clinician acceptance of the technology was assessed by surveys. Results: In the 6 months following the intervention, HIV testing rates increased 555% and combined HBV/HCV testing rates increased 362%. No significant differences were observed for any BBV testing rates in the nonintervention practices over the same period. Monthly testing rates declined towards baseline after initial increases. Clinician's perceptions of the prompt system were positive, with average additional time required for BBV test discussion in consultations estimated at 2 min. The patient survey also showed high acceptance of the technology. Conclusion: This pilot study demonstrated that BBV_TP1 increased BBV testing rates in primary care via targeted screening, although testing rates subsequently fell whilst the application remained active. Such systems can potentially reduce late diagnoses, while having high acceptance by clinicians and patients. Larger studies with longer follow-up are needed to demonstrate efficacy and cost-effectiveness.