Systematic Reviews and Meta-analyses
eHealth Technologies for Screening, Diagnosis, and Management of Viral Hepatitis: A Systematic Review

https://doi.org/10.1016/j.cgh.2020.09.011Get rights and content

Background & Aims

Chronic viral hepatitis is a leading cause of worldwide liver-related morbidity and mortality, despite the availability of effective treatments that reduce or prevent complications in most patients. Electronic-health (eHealth) technologies have potential to intervene along the whole cascade of care. We aimed to summarize available literature on eHealth interventions with respect to conventional screening, diagnostic and treatment outcomes in chronic hepatitis B (HBV) and hepatitis C (HCV).

Methods

We systematically reviewed MEDLINE, EMBASE, Cochrane Library and international conference abstracts, including studies published from 2009 – 2020. Overall 80 studies were included, covering electronic medical record (EMR) interventions (n=39), telemedicine (n=20), mHealth (n=5), devices (n=4), clinical decision support (n=3), web-based (n=5), social media (n=1) and electronic communication (n=3).

Results

Compared to standard care, EMR alerts increase screening rates in eligible populations including birth cohort screening in HCV, universal HCV screening in Emergency Departments, ethnic groups with high HBV prevalence, and HBV screening prior to immunosuppression. Direct messaging alerts to providers and automated testing may have a greater effect. No significant difference was found in sustained virological response outcomes between telemedicine and face-to-face management for community, rural and prison cohorts in HCV in the direct acting antiviral era of treatment, with higher patient satisfaction in telemedicine groups.

Conclusions

EMR alerts significantly increase screening rates in eligible cohorts in both chronic HBV and HCV. Telemedicine is equally efficacious to face-to-face care in HCV treatment. Other eHealth technologies show promise; however rigorous studies are lacking.

Section snippets

Materials and Methods

We performed a systematic review of the literature in July 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (Supplementary Table 1). This systematic review was prospectively registered on the NIHR Prospero database (registration number: CRD42018084582).

Study Selection

A total of 1979 studies were identified. After removal of duplicate entries, title and abstract review, 140 studies were retained for full-text review. Supplementary Figure 1 outlines the PRISMA flow diagram outlining search and identification outcomes. After full-text review, 80 studies were included in the final analysis (Supplementary Material). The first identified study was in 2009, with an increase in published eHealth interventions for viral hepatitis year on year from 2012 onwards.

Impact of eHealth Interventions

A rapid growth in eHealth research in viral hepatitis has provided strong evidence that EMR alerts improve screening rates in HBV and HCV and for the use of telemedicine in the treatment of HCV in both community and prison settings. Directly messaging providers and automated electronic ordering based on high risk patient factors appear to further enhance the yield in EMR-based interventions, and telementoring may increase treatment initiation rates in the community for HCV. Web-based, mHealth,

Conclusions

Electronic medical record alerts significantly improve screening rates in both hepatitis B and C, and the addition of automated testing in high risk cohorts may further enhance this. Telemedicine for community and prison-based hepatitis C management yields equivalent clinical outcomes to face-to-face specialist management in hepatitis C and may result in higher patient satisfaction. The addition of telementoring increases community-based treatment initiation in HCV and improves clinician

CRediT Authorship Contributions

James Haridy, MBBS, MPH, B Physio, CHIA, FRACP (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Methodology: Lead; Project administration: Lead; Writing – original draft: Lead; Writing – review & editing: Lead)

Guru Iyngkaran (Conceptualization: Supporting; Formal analysis: Supporting; Writing – review & editing: Supporting)

Amanda Nicoll (Conceptualization: Supporting; Writing – original draft: Supporting; Writing – review & editing: Supporting)

Geoff Hebbard (Writing –

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    Conflicts of interest These authors disclose the following: JH has received speaker fees from Merck-Sharpe-Dohme and Bristol-Myer Squibbs unrelated to this study. GI and ET are shareholders in Gessit Pty Ltd and have received research grants from Merck-Sharpe-Dohme, Bristol-Myer-Squibbs, and AbbVie unrelated to this study. AJN has received speaker fees and research support from MSD, Bayer, BMS, Eisai, Ipsen, and AbbVie unrelated to this study. The remaining authors disclose no conflicts.

    Funding JH is supported on an Australian Government Research Training Scholarship.

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