Primary Care Provider Practice Patterns and Barriers to Hepatocellular Carcinoma Surveillance
Primary Care Provider Practice Patterns and Barriers to Hepatocellular Carcinoma Surveillance
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DOI：
10.1016/j.cgh.2018.07.029
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发表时间：
2019-03-01
影响因子：
12.6
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
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作者：
Simmons, Okeefe L.;Feng, Yuan;Singal, Amit G.
背景与目的：肝细胞癌（HCC）监测率低主要是由于提供者相关的过程失败.然而，很少有研究评估初级保健提供者（PCP）的实践模式，态度和障碍，HCC监测在学术三级医疗referral centers.METHODS：我们进行了基于网络的调查，PCP在2个三级医疗转诊中心（133提供者）从2017年6月至2017年12月。该调查改编自预先测试的调查，包括有关实践模式，态度和HCC监测障碍的问题。我们使用了Fisher精确和Mann-Whitney秩和检验来确定与坚持HCC监测建议相关的因素，分别为分类和连续变量，分别为75%和100%（133提供者）的临床水平应答率。尽管大多数PCP自己进行HCC监测，但三分之一的PCP将监测推迟到专科医生，并将患者转诊到肝病诊所。供应商认为超声和甲胎蛋白分析的组合对于早期肿瘤检测非常有效，并报告使用该组合评估大多数患者。然而，对于非酒精性脂肪性肝炎或失代偿性肝硬化患者，PCP更可能使用基于计算机断层扫描或磁共振成像的监测。大多数供应商认为HCC监测对于早期肿瘤检测和提高生存率是有效的。然而，他们希望增加高质量的证据来描述筛查的益处和危害。提供者表达了对HCC监测的明显误解，包括肝酶水平测量在HCC监测中的作用以及无肝硬化患者监测的成本效益。他们还报告的障碍，包括没有被最新的肝癌监测建议，有限的时间在诊所，和竞争的临床concerns.CONCLUSIONS：在一个基于网络的调查，PCP报告的误解和肝癌监测的障碍。这表明需要采取干预措施，包括提供者教育，以提高临床实践中HCC监测的有效性。
BACKGROUND & AIMS: Low rates of hepatocellular carcinoma (HCC) surveillance are primarily due to provider- related process failures. However, few studies have evaluated primary care provider (PCP) practice patterns, attitudes, and barriers to HCC surveillance at academic tertiary care referral centers.METHODS: We conducted a web-based survey of PCPs at 2 tertiary care referral centers (133 providers) from June 2017 through December 2017. The survey was adapted from pretested surveys and included questions about practice patterns, attitudes, and barriers to HCC surveillance. We used the Fisher exact and Mann-Whitney rank-sum tests to identify factors associated with adherence to HCC surveillance recommendations, for categoric and continuous variables, respectively.RESULTS: We obtained a provider-level response rate of 75% and clinic-level response rate of 100% (133 providers). Whereas most PCPs performed HCC surveillance themselves, one-third deferred surveillance to subspecialists and referred patients to a hepatology clinic. Providers believed the combination of ultrasound and a-fetoprotein analysis to be highly effective for early stage tumor detection and reported using the combination for assessment of most patients. However, PCPs were more likely to use computed tomography- or magnetic resonance imaging-based surveillance for patients with nonalcoholic steatohepatitis or decompensated cirrhosis. Most providers believed HCC surveillance to be efficacious for early tumor detection and increasing survival. However, they desired increased high-quality evidence to characterize screening benefits and harms. Providers expressed notable misconceptions about HCC surveillance, including the role for measurement of liver enzyme levels in HCC surveillance and cost effectiveness of surveillance in patients without cirrhosis. They also reported barriers, including not being up to date on HCC surveillance recommendations, limited time in the clinic, and competing clinical concerns.CONCLUSIONS: In a web-based survey, PCPs reported misconceptions and barriers to HCC surveillance. This indicates the need for interventions, including provider education, to improve HCC surveillance effectiveness in clinical practice.