1. 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 GERVIH Groupe d’études et de recherches Ville-Hôpital 1

2. 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 2/24

3. 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 3/24

4. 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 4/24

5. 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. 5/24

6. 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 6/24

7. 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 7/24

8. 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? 8/24

9. 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… 9/24

10. Logical management 10/24 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)

11. Let’s have a laugh AG HBsOOOOOOOOOOOOOOOOOO Anti HBsOOOOOOPPPPPPNNNNNN Anti HBcOOPPNNOOPPNNOOPPNN DelayLMLMLMLMLMLMLMLMLM StrategyMMMMMMPPPPPPMMMMMM AG HBsPPPPPPPPPPPPPPPPPP Anti HBsOOOOOOPPPPPPNNNNNN Anti HBcOOPPNNOOPPNNOOPPNN DelayLMLMLMLMLMLMLMLMLM StrategyBRBRBREEEEEEBRBRBR AG HBsNNNNNNNNNNNNNNNNNN Anti HBsOOOOOOPPPPPPNNNNNN Anti HBcOOPPNNOOPPNNOOPPNN DelayLMLMLMLMLMLMLMLMLM StrategyMMTTMMPPPPPPIMXXII 11/24

12. 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 12/24

13. 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… 13/24

14. Thank you for your attention… 14/24

15. A FEW SCREENS 15/24

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