PREVAC B: an internet-based program to help GPs manage

hepatitis B prevention

AUBERT Jean-Pierre, DI PUMPO Alexandrine, EDDI Alain  ,

NOUGAIREDE Michel, HUAS Caroline, BAUMANN Laurence ,

LEPOUTRE Bruno, WAJSBROT Alain , GERVAIS Anne,

.

Dept of General Practice, University Paris VII, Paris, France

WONCA Europe, Istanbul, Sept 3, 2008

GERVIHGroupe d’études et de recherches Ville-Hôpital 1

What’s the problem?

54 serologic situations are possible regarding HBV serology results.

GPs need a tool to help them manage HBV prevention

An internet-based program allows tight control of data collection for research, at lower cost

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PREVAC B

A study to determine whether GPs are able to make individual prevention of HBV, adapted to each serologic profile (HBV free, HBV protected, HBV carrier)

The study required to collect HBV serologic datas from the medical files

The program had to give an advice on which prevention skill had to be use for each patient

An information leaflet was uploaded by the doctor, related to individual serologic profile

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Acces to the tool

No access code, because investigators are unable to remember an access code, even his own nam

Thus no access is possible from a public site

solution The investigator receives by mail a personal internet adress for

the study, with no access code http://www.reseau-paris-nord.com/prevacb/prevacb.accueil.php?numero_investigateur=58

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First issue: include the first patient

If one patient is included,… at least ten will be If the investigator doesn’t include during the first week, he forgets

the study… Solution: one mail per week till first inclusion In each mail, remind the investigator how to start

….If no inlusion within one month: HUMAN phone call (20% investigators need it to start study)

YOU NEED A MEDICAL STUDENT AS A SLAVE.

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Logical management Three available markers

HBs AG, anti HBs AB, anti HBc AB Collection of data within medical file

Each marker can be Positive (P), Negative (N) or not available (O) Collection of delay since the test has been done

Two values: more (M) or less than one year (L) Number of situations: 3*3*3*2=54 NOPL means:

HBs AG neg, anti HBs AB not available, anti HBc AB positive, test done less than one year ago

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Logical management The program has to classify patients into three groups: HBV free,

HBV carriers, HBV protected When the serology is complete it is (most of the time) possible to

classify patient into one of those groups For example

NNNL is HBV free NPPM is HBV protected PNPL is HBV carrier

Collected datas are related to the LAST results found in the medical file

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Logical issues

When serology is not recent: NNNM was HBV free more than one year ago.

Has he been contamined since this test ?

When serology is not complete ONPM has had contact with virus. But is he HBV

carrier?

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Logical issues If the doctor has done his job, he should have already applied the

prevention skill (without help of the program)

NNNL had to be vaccinated at the time of the test.. Maybe the vaccination has already been started

Thus the program has to ask wether a vaccination has been started, and how many injections have already been done… before it can propose a strategy

As we can see, data collection is rather complex…

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Logical management

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After collection of serologic data, seven classes of strategies may be oserved:

1. Impossible data or incomplete datas: new serology has to be done

2. HBV free (recent): collect datas about vaccination, complete vaccination and give targeted leaflet

3. HBV free (old): collect datas about vaccination, or new serology if vaccination not started

4. HBV protected: give targeted leaflet

5. HBV carrier (recent): give targeted leaflet

6. HBV carrier (old): new serology

7. NNPL or NNPR or NOPL or NOPR : give choice to he investigator (no consensus within guidelines)

Let’s have a laughAG HBs O O O O O O O O O O O O O O O O O O

Anti HBs O O O O O O P P P P P P N N N N N N

Anti HBc O O P P N N O O P P N N O O P P N N

Delay L M L M L M L M L M L M L M L M L M

Strategy M M M M M M P P P P P P M M M M M M

AG HBs P P P P P P P P P P P P P P P P P P

Anti HBs O O O O O O P P P P P P N N N N N N

Anti HBc O O P P N N O O P P N N O O P P N N

Delay L M L M L M L M L M L M L M L M L M

Strategy B R B R B R E E E E E E B R B R B R

AG HBs N N N N N N N N N N N N N N N N N N

Anti HBs O O O O O O P P P P P P N N N N N N

Anti HBc O O P P N N O O P P N N O O P P N N

Delay L M L M L M L M L M L M L M L M L M

Strategy M M T T M M P P P P P P I M X X I I

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Computerized follow-up

Automatic e-mails:

Remind investigators to include Confirm each inclusion Confirm each end of study Individual weekly summary of investigators’ patients

status

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Conclusion We have worked a lot to determine the logical structure

of the program

We have worked a lot to write the program

But finally data collection was very easy

And the program can be used for other purposes than research (public health)

It’s worth the fighting for…

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Thank you for your attention…

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A FEW SCREENS

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