Ｂ型肝炎ウイルス再活性化対策に関するガイドライン遵守のための取り組み

抄録

With hepatitis B virus reactivation, it is crucial to identify patients with high-risk of contracting fatal hepatitis and initiate a prophylactic antiviral treatment. Since April 2016, our institution has introduced a systematic program to encourage prophylactic action for all patients using immunosuppressive agents. High-risk patients were identified in a data warehouse of our electronic medical chart system by applying an in-house software. An alert message was sent to the attending doctor in one of three ways. Strategy 1 was a direct message on paper from the pharmacist monitoring chemotherapy regimens or an on-screen notification two weeks after prescriptions of other immunosuppressants. Strategy 2 was an on-screen notification to remind the risk of prescription followed by a message on paper after two weeks. Strategy 3 was an on-screen notification only. The number of doctors who followed all steps in the guideline within four weeks of prescription were calculated. Rates of successful completion for each strategy were then compared using Ryan's multiple range test. The completion rates were 35.2％ (n = 193), 72.6％ (n = 449), 66.6％ (n = 413), and 50.0％ (n = 50) in no program and Strategies 1 through 3, respectively. They were significantly different in all combinations (P < 0.01 or P < 0.05) excluding the comparisons between no program and Strategy 3 or between Strategies 1 and 2. It is suggested that alerting doctors on paper is an effective measure to promote prophylactic action, while the efficacy of on-screen notifications was limited even when shown during prescription.