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Friday, September 17, 2010

Hepatitis B Prevention Program Gaining Traction in San Francisco

Author: Steven Fox | Download PDF | See online version

September 17, 2010 (San Francisco, California) — A unique community-based program aimed at preventing hepatitis B in the high-risk Asian population is effectively combining provocative advertising with electronic medical records (EMRs) to maximize its success.

The program, known as San Francisco Hep B Free, is a collaborative effort of more than 50 private and public organizations that was launched 3 years ago. It sponsors numerous screening clinics, works with hospitals and primary care physicians to make screening a part of routine care, and tracks the treatment of people who are already infected with the virus.

The program works with hospitals to get pledges from physicians to routinely screen their patients for the presence of hepatitis B virus. So far, nearly half the primary care physicians in the city have signed on to the program. They have agreed to assess all at-risk patients according to Centers for Disease Control and Prevention guidelines. Three facilities — Kaiser Permanente San Francisco, the Chinese Hospital, and Northeast Medical Services — have achieved 100% physician buy-in to the program.

Challenges remain, however. "Changing practice patterns of primary care physicians is the most difficult aspect of what we do," said Ted Fang, an Asian community organizer who helped get Hep B Free started and who now works with scores of other community organizers and healthcare professionals to steer the program. "That's because of all the responsibilities doctors already have and the limited time they have to spend with each patient."

The need for attention to hepatitis B is hardly at issue, Mr. Fang noted. The disease is the prime causative factor in about 80% of liver cancers, according to World Health Organization figures, and San Francisco has the highest rate of liver cancer in the nation — about 14 cases per 100,000, compared with 9.5 cases per 100,000 in the rest of the country.

Hep B Free operates 7 stand-alone screening clinics and hosts community screening fairs that are aimed at reaching uninsured and underinsured patients.

A print and television advertising campaign that made its debut in May 2010 has helped bolster awareness of the Hep B Free program — but it has also raised a few eyebrows. Each ad features a different group of Asians — beauty queens, athletes, office workers, physicians — with the caption: "Which one deserves to die?"

Mr. Fang concedes it's a strong approach, but said the ads have produced the desired result: getting people talking about the disease, both among themselves and with their doctors. The print ads are being published in Chinese, Vietnamese, and Korean, and in English because one of the target groups is English-speaking physicians who might not be aware of the prevalence of the disease in the Asian community.

EMRs play a role in making the Hep B Free program a success. They are put to use in several phases of the program:

* For people who don't know their hepatitis B status, EMRs can be flagged to ensure that they are properly screened.

* For people being vaccinated, EMRs help track compliance to the full vaccination series (3 injections administered over 6 months).

* For people chronically infected, EMRs can generate reminders to contact patients for annual or semiannual monitoring.

"There is no way we can improve healthcare outcomes unless we can evaluate the effectiveness of current medical services," said Mr. Fang. "EMRs not only remind doctors to carry out important procedures, they also help evaluate which methods of prevention work best and which we need to improve."

Another major partner in administering the Hep B Free program is the San Francisco Department of Public Health (DPH). Janet Zola, MPH, is disease prevention and health promotion specialist there, and was a key player in developing the Hep B Free program.

That was just the start. According to Ms. Zola, "the DPH allows me to use a large percentage of my time to run the campaign, coordinate activities, and do strategic planning."

She added that she's learned several important lessons from running the program. "Resources can be leveraged without waiting for an infusion of large amounts of money," she explained. Getting cooperation from local hospitals is important, but community support has been essential to the success of the program so far, she asserted. "Volunteerism is alive and well," she added. "This is more than an Asian problem. It is an American problem."

The success of San Francisco Hep B Free hasn't gone unnoticed. Other California cities, plus Philadelphia, Pennsylvania, and Washington, DC, are working to replicate the program.

That progress is good news to Baruch Blumberg, MD, PhD, who has a special interest in hepatitis B. He received the Nobel Prize for Medicine in 1976 for his discovery of the hepatitis B virus, and later developed the first effective vaccine for the disease. The vaccine became available in the early 1980s.

Dr. Blumberg was recently honored at a dinner reception jointly sponsored by the Hep B Free program and the Chinese Hospital.

Noting that vaccines and effective treatments for hepatitis B are now potentially available worldwide, Dr. Blumberg told Medscape Medical News that the key to reducing the toll of the disease lies in continuing to increase awareness.

"These good outcomes can only be fully achieved if the public, and particularly populations with a high rate of infection, including those of Asian origin, are aware of the problem and take part in programs that include vaccination, detection, and treatment," said Dr. Blumberg.

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