Medical informatics is mainly used for communication between medical staff. Medical informatics applications that engage patients can improve the efficiency a patient's time in a physicians's office or medical clinic. Audio-Computer Assisted Survey Interview (audio- CASI) is “Patient targeted informatics” that increases reporting of behaviors associated with sexual behavior, drug use, and violence by up to 15 fold. Audio-CASI allows respondents to answer embarrassing questions without direct participation of an interviewer and avoids obstacles such as poor literacy. Respondents can use multiple languages, listen to and read questions simultaneously. We have been running a program using audio-CASI based Hepatitis Survey Kiosk (HSK) in an urban Federally Qualified Health Center (FQHC) and an academic charity care clinic in Newark New Jersey.
Patient Navigator-PN, Hepatitis Data Coordinator & Laison-HDCL
Of 1016 patient survey initiations, 980 patients completed the survey. Thirty patients initiated the survey, but did not give consent. Four patients gave consent but did not complete the survey. Of the 980 patients who completed the survey, 246 acknowledged having “ANY” risk factor. There were 681 (75%) females and 299 (25%) males who completed the survey. The race and ethnicity of the patients were as follows: 403 Non-Hispanic Black, 104 Other, 269 Hispanic White, 66 Hispanic Black, 28 Pacific Islander, 36 Native American, 54 Non-Hispanic White, and 15 Asian. Language use was: 630 English, 70 Creole and 286 Spanish. The distribution for region of birth was: 331
9North America, 282 Caribbean, 116 South America (non Amazon Basin), 33 Sub-Sahara Africa, 48 Central America, 62 Amazon Basin, 16 North Africa, 6 Pacific Islands or Rim, 6 South East Asia, 6 East Europe, 5 Western Europe, 3 Central Asia, 4 Middle East, and 68 unknown. Of 246 patients identified in need of blood testing for chronic viral hepatitis, 150 patients had a complete chronic hepatitis screen (HCV antibody, HBV surface antigen, HBV core antibody, HBV surface antibody). Patient blood testing for chronic viral hepatitis was: 14 HCV antibody positive, 6 HBV surface antigen positive, 8 HBV core positive/surface antibody negative/surface antigen negative, 22 HBV core positive/surface antibody positive, and 96 HBV surface/core antibody and surface antigen negative. Of the 96 patients who were HBV naïve, 65 (67%) acknowledged having “ANY” risk factor for chronic viral hepatitis. Thus far 70 patients are in the process or have completed HBV vaccination. Of six patients testing HBV surface antigen positive, 3 were Haitian, and 1 was Sub-Sahara African. Only one of the six HBV surface antigen positive patients acknowledged having “ANY” risk factor for chronic viral hepatitis. Of 14 patients testing HCV antibody positive, 11 acknowledged having “ANY” risk factor for chronic viral hepatitis. Of patients in need of HBV vaccine, 34% were identified as a result region of endemic risk only. As an internal control, we asked patients if they had a history of viral hepatitis and assessed the number of patients acknowledging “ANY” risk factor or birth in a region of endemic infection. 37 of 66 (56%) patients noting a history of viral hepatitis acknowledged “ANY” risk factor. An additional 6 patients noting a hepatitis history, not acknowledging a risk factor, were born in a region of endemic risk. Of the 66 patients indicating a hepatitis history, hepatitis blood test results were available in 27 patients. Of these 27 patients, 7 were HCV antibody positive, 1 was HBV surface antigen positive, and 14 were HBV naive.