Hepatitis C Patients with Cirrhosis in Primary Care Clinics: Implementing Evidence-Based. Guidelines

Transcription

1 Hepatitis C Patients with Cirrhosis in Primary Care Clinics: Implementing Evidence-Based Guidelines Poster Presentation Handout for Scholarly Event March 26, 2013 Michelle M. Lisowski NURS 770: Clinical Scholarship IV Winona State University

2 Educational Items Distributed to Primary Care Providers 1. Clinicians Guide The full text or pdf of this document can be found and downloaded at This document is not copyrighted and users are encouraged to print and distribute as many copies as they need.

3 2. Laminated Pocket Card Cirrhosis Treatment Recommendations HCC surveillance (every 6 months): Ultrasound AFP No varices Part of the Cirrhosis Quicknotes which constitute an abbreviated version of the Management and Treatment of Patients with Cirrhosis and Portal Hypertension (2009), developed by the Department of Veterans Affairs Hepatitis C Resource Center Program. Repeat endoscopy in 3 years (sooner if decompensation occurs) Management of compensated cirrhosis (no ascites, variceal hemorrhage, encephalopathy, or jaundice) Varices surveillance (upper endoscopy) Small varices In a CTP class B or C patient or varices with red signs In a CTP class A patient, without red signs Nonselective betablockers (propranolol or nadolol) Nonselective beta-blockers optional Start propranolol (20 mg BID) or nadolol (40 mg QD) Titrate to maximum tolerable dosage or a heart rate of beats/min No need to repeat endoscopy If no beta-blockers given, repeat endoscopy in 2 years (sooner if decompensation occurs) Medium/Large varices prevention of first variceal hemorrhage Nonselective beta-blockers (propranolol, nadolol) OR Endoscopic variceal ligation (choice depends on patient characteristics and preferences, local resources) Start propranolol (20 mg BID) or nadolol (40 mg QD) Titrate to maximum tolerable dosage or a heart rate of beats/min No need to repeat endoscopy Ligate every 1-2 weeks until variceal obliteration First surveillance endoscopy 1-3 months after obliteration, then every 6-12 months indefinitely

4 3. Hepatocellular Carcinoma Pocket Card from GuidelineCentral.com (Pocket card is copyrighted not able to past to this document) Article on diagnosing cirrhosis sent to providers 1-2 weeks post educational seminar: Udell, J. A., Wang, C. S., Tinmouth, J., FitzGerald, J. M., Ayas, N. T., Simel, D. L.,... Yoshida, E. M. (2012). Does this patient with liver disease have cirrhosis? The Journal of the American Medical Association, 307(8),

5 References Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. St. Louis, Missouri: Mosby Elsevier. Bacon, B. R., O'Grady, J. G., Di Bisceglie, A. M., & Lake, J. R. (2006). Comprehensive clinical hepatology. Philadelpha, Pennsylvania: Mosby. Bruix, J., & Sherman, M. (2005). Management of hepatocellular carcinoma. Hepatology, 42(5), Bruix, J., & Sherman, M. (2011). management of hepatocellular carcinoma: An update. Hepatology, 53(3), doi: /hep Center for Quality Management in Public Health. (2010). The state of care for Veterans with chronic hepatitis C. Palo Alto: U.S. Department of Veteran Affairs, Publich Health Strategic Health Care Group, Center for Quality Management in Public Health. Retrieved from Chou, A. F., Vaughn, T. E., McCoy, K. D., & Doebbeling, B. N. (2011). Implementation of evidence-based practices: Applying a goal commitment framework. Health Care Management Review, 36(1), doi: /hmr.0b013e3181dc8233 Cohen, S. M., & Kataoka-Yahiro, M. (2010). Provider adherence to clinical guidelines related to lipid-lowering medications. Military Medicine, 175, Craig, T. J., Perlin, J. B., & Fleming, B. B. (2007). Self-reported performance improvement strategies of highly successful Veterans Health Administration facilities. American Journal of Medical Quality, 22, doi: / Demakis, J. G., Beauchamp, C., Cull, W. L., Denwood, R., Eisen, S. A., Lofgren, R.,... Henderson, W. G. (2000). Improving residents' compliance with standards of ambulatory care: Results from the VA cooperative study on computerized reminders. Journal of the American Medical Association, 284(11), Flanagan, M. E., Ramanujam, R., & Doebbeling, B. N. (2009). The effect of provider and workflow focused strategies for guideline implementation on provider acceptance. Implementation Science, 4(71), 1. doi: / Garcia-Tsao, G., Sanyal, A. J., Grace, N. D., & Carey, W. (2007). Prevention and management of gastoesophageal varices and variceal hemorrhage in cirrhosis. Hepatology, Goetz, M. B., Hoang, T., Bowman, C., Knapp, H., Rossman, B., Smith, R.,... Asch, S. M. (2008). A system-wide intervention to improve HIV testing in the Veterans Health

6 Administration. Journal of General Internal Medicine, 23(8), doi: /s Grol, R., Wensing, M., Hulscher, M., & Eccles, M. (2005). Theories on implemtation of change in healthcare. In R. Grol, M. Wensing, & M. Eccles, Improving patient care: The implementation of change in clinical practice (pp ). Edinburgh: Elsevier Butterworth Heinemann. Hysong, S. J., Best, R. G., & Pugh, J. A. (2007). Clinical practice guideline implementatin strategy patterns in Veteran Affairs primary care clinics. Health Research and Educational Trust, 42(1), doi: /j x Nouso, K., Tanaka, H., Uematsu, S., Shiraga, K., Okamoto, R., Onishi, H.,... Shiratori, Y. (2008). Cost-effectiveness of the surveillance program of hepatocellular carcinoma depends on the medical circumstances. Hepatology, 23, doi: /j x O'Connor, S., Ward, J. W., Watson, M., Momin, B., & Richardson, L. C. (2010). Hepatocellular Carcinoma---United States, Centers for Disease Contorl and Prevention. Washington, DC: U.S. Government Printing Office. Richardson, W. S., Wilson, M. C., Nishikawa, J., & Hayward, R. S. (1995). The well-built clinical question: A key to evidence-based decision. ACP Journal Club, 123(3), A12- A13. Saleem, J. J., Patterson, E. S., Militello, L., Render, M. L., Orshansky, G., & Asch, S. (2005). Exploring barriers and facilitators to the use of computerized clinical reminders. Journal of the American Medical Informatics Association, 12(4), doi: /jamia.m1777. Schlosser, R. W., Koul, R., & Costello, J. (2007). Asking well-built questions for evidence-based practice in augmentative and alternative communication. Journal of Communication Disorders, 40, doi: /j.jcomdis Spiegel, B. M., Esrailian, E., & Eisen, G. (2007). The budget impact of endoscopic screening for esophageal varices in cirrhosis. Gastrointestinal Endoscopy, 66(4), doi: /j.gie Stetler, C. B., Mittman, B. S., & Francis, J. (2008). Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI series. Implementation Science, 3(8), doi: / Stravitz, R. T., Heuman, D. M., Chand, N., Sterling, R. K., Shiffman, M. L., Luketic, V. A.,... Fisher, R. A. (2008). Surveillance for hepatocellular carcinoma in patients with cirrhosis

7 improves outcome. The American Journal of Medicine, 21, doi: /j.amjmed Udell, J. A., Wang, C. S., Tinmouth, J., FitzGerald, J. M., Ayas, N. T., Simel, D. L.,... Yoshida, E. M. (2012). Does this patient with liver disease have cirrhosis? The Journal of the American Medical Association, 307(8), Xu, J., Kochanek, K. D., Murphy, S. L., & Tejada-Vera, B. (2010). Deaths: Final data for National Vital Statistics Reports, 58(19), 1-73.