Physician Nonadherence With a Hepatitis C Screening Program
Physician Nonadherence With a Hepatitis C Screening Program
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DOI：
10.1097/qmh.0000000000000007
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发表时间：
2014-01-01
影响因子：
1.2
通讯作者：
Litwin, Alain H.
中科院分区：
文献类型：
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作者：
Southern, William N.;Drainoni, Mari-Lynn;Litwin, Alain H.
背景资料：建议对有丙型肝炎病毒（HCV）感染风险的患者进行检测，但目前尚不清楚提供者是否遵守检测指南。我们的目的是衡量在多方面的持续干预期间对HCV筛查方案的依从性。主题和方法：前瞻性队列设计旨在检查患者层面、医生层面和就诊层面特征与HCV筛查方案依从性之间的关联。研究参与者包括所有在3家研究诊所之一就诊的患者和护理他们的医生。对HCV筛查方案的依从性和患者水平、医生水平和访视水平的依从性预测因子进行了测量。结果：共有8981名患者和154名医生接受了检查。总体方案依从率为36.1%。在多变量分析中，患者男性（比值比[OR] = 1.18）、新患者（OR = 1.23）、早晨访视（OR = 1.32）和患者首选语言为非英语（OR = 0.87）与筛选依从性显著相关。医生的总体依从性差异很大（范围，0%-92.4%）。筛选依从性从研究第1周的59.1%持续下降至第15周（最后一周）的13.7%。在实施复杂的临床实践指南时，规划者应解决医生态度上的障碍以及知识上的差距，以最大限度地提高依从性。
Background: Testing for patients at risk for hepatitis C virus (HCV) infection is recommended, but it is unclear whether providers adhere to testing guidelines. We aimed to measure adherence to an HCV screening protocol during a multifaceted continuous intervention. Subjects and Methods: Prospective cohort design to examine the associations between patient-level, physician-level, and visit-level characteristics and adherence to an HCV screening protocol. Study participants included all patients with a visit to 1 of the 3 study clinics and the physicians who cared for them. Adherence to the HCV screening protocol and patient-level, physician-level, and visit-level predictors of adherence were measured. Results: A total of 8981 patients and 154 physicians were examined. Overall protocol adherence rate was 36.1%. In multivariate analysis, patient male sex (odds ratio [OR] = 1.18), new patient (OR = 1.23), morning visit (OR = 1.32), and patients' preferred language being non-English (OR = 0.87) were significantly associated with screening adherence. There was a wide variation in overall adherence among physicians (range, 0%-92.4%). Screening adherence continuously declined from 59.1% in week 1 of the study to 13.7% in week 15 (final week). When implementing complex clinical practice guidelines, planners should address physician attitudinal barriers as well as gaps in knowledge to maximize adherence.