Provider, Patient, and Practice Factors Shape Hepatitis B Prevention and Management by Primary Care Providers
Provider, Patient, and Practice Factors Shape Hepatitis B Prevention and Management by Primary Care Providers
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DOI：
10.1097/mcg.0000000000000738
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发表时间：
2017-08-01
影响因子：
2.9
通讯作者：
Khalili, Mandana
中科院分区：
文献类型：
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作者：
Mukhtar, Nizar A.;Kathpalia, Priya;Khalili, Mandana
目的：评估提供者的知识，态度和障碍，B型肝炎病毒（HBV）的护理和管理实践在不同的初级保健settings.Background：因素影响遵守建议的HBV筛查和管理guidelines定义不清。材料和方法：在旧金山弗朗西斯科各种医疗保健设置的提供者进行了调查。多变量分析用于确定与推荐的HBV筛查，疫苗接种和疾病monitoring.Results相关的因素：277（41.3%）响应供应商，42%的报告进行HBV筛查>50%的高危患者，49%，HBV疫苗接种>50%的合格患者。大多数人报告说，对大多数HBV感染患者每6至12个月进行一次丙氨酸氨基转移酶（79%）和HBV病毒载量（67%）的适当监测，但对49%的患者进行了任何肝细胞癌筛查。与HBV筛查显著相关的提供者因素是说亚洲语言[比值比（OR），3.27]，提供HBV治疗（OR，3.00），有>25%的亚洲患者在实践中（OR，2.10），在安全网环境中实践（OR，7.51）和具有较高的障碍评分（OR，0.74）。适当的HBV监测与提供者讲亚洲语言（OR，3.43）和提供者年龄（OR，0.68/十年）相关。肝细胞癌筛查与25%以上的患者将英语作为第二语言（OR，4.26）和在安全网环境中练习（OR，0.14）相关。结论：无论实践环境如何，遵守HBV指南的比率都是次优的，并且受到某些提供者，患者和实践因素的影响。这项研究强调了让初级保健提供者参与制定、传播和实施循证HBV实践指南的重要性。
Goals:To evaluate provider knowledge, attitudes and barriers to hepatitis B virus (HBV) care and management practices across diverse primary care settings.Background:Factors influencing adherence to recommended HBV screening and management guidelines are poorly defined.Materials and Methods:Providers across various health care settings in San Francisco were surveyed. Multivariate analyses were used to identify factors associated with recommended HBV screening, vaccination, and disease monitoring.Results:Of 277 (41.3%) responding providers, 42% reported performing HBV screening in >50% of at-risk patients, and 49%, HBV vaccination in >50% of eligible patients. Most reported appropriate monitoring of a majority of HBV-infected patients with alanine aminotransferase (79%) and HBV viral load (67%) every 6 to 12 months, but performed any hepatocellular carcinoma screening in 49%. Provider factors significantly associated with HBV screening were speaking an Asian language [odds ratio (OR), 3.27], offering HBV treatment (OR, 3.00), having >25% of Asian patients in practice (OR, 2.10), practicing in safety net settings (OR, 7.51) and having higher barrier score (OR, 0.74). Appropriate HBV monitoring was associated with provider speaking an Asian language (OR, 3.43) and provider age (OR, 0.68/decade). Hepatocellular carcinoma screening was associated with having >25% of patients speaking English as a second language (OR, 4.26) and practicing in safety net settings (OR, 0.14).Conclusions:Rates of adherence to HBV guidelines were suboptimal irrespective of practice setting and were influenced by certain provider, patient and practice factors. This study reinforces the importance of engaging primary care providers in development, dissemination, and implementation of evidence-based HBV practice guidelines.