Assessment of HBV Preventive Services in a Medically Underserved Asian and Pacific Islander Population Using Provider and Patient Data

Abstract

BACKGROUND: Hepatitis B (HBV) represents a significant health disparity among medically underserved Asian and Hawaiian/Pacific Islander (API) populations. Studies evaluating adherence to HBV screening and vaccination guidelines in this population are limited. OBJECTIVE: The purpose of this study was to evaluate HBV screening and vaccination practices using both provider self-report and patient records. DESIGN: Medical records for 20,574 API adults were reviewed retrospectively and primary care providers were surveyed to evaluate rates and adherence to HBV screening and vaccination guidelines. PARTICIPANTS: The study included primary care providers and their adult API patients in the San Francisco safety-net healthcare system. MAIN MEASURES: Patient, practice, and provider factors, as well as HBV screening and vaccination practices, were assessed using provider survey constructs and patient laboratory and clinical data. Generalized linear mixed models and multivariate logistic regression analyses were used to identify factors associated with recommended HBV screening and vaccination. KEY RESULTS: The mean age of patients was 52 years, and 63.4 % of patients were female. Only 61.5 % underwent HBV testing, and 47.4 % of HBV-susceptible patients were vaccinated. Of 148 (44.8 %) responding providers, most were knowledgeable and had a favorable attitude towards screening, but 43.2 % were unfamiliar with HBV guidelines. HBV screening was positively associated with favorable provider attitude score (OR per unit 1.80, 95 % CI 1.18-2.74) and negatively associated with female patient sex (OR 0.82, 95 % CI 0.73-0.92), a higher number of clinic patients per week (OR per 20 patients 0.46, 95 % CI 0.28-0.76), and provider barrier score (OR per unit 0.45, 95 % CI 0.24-0.87). HBV vaccination was negatively associated with provider barrier score (OR per unit 0.48, 95 % CI 0.25-0.91). CONCLUSIONS:Rates of HBV screening and vaccination of API patients in this safety-net system are suboptimal, and provider factors play a significant role. Efforts to cultivate positive attitudes among providers and expand healthcare system resources to reduce provider barriers to HBV care are warranted. 1 Asian and Hawaiian/Pacific Islanders (API) represent a particularly high-risk population, with reported prevalence rates of 10-15 %, and are estimated to account for over 40 % of chronic HBV cases in the U.S. 2HBV is associated with increased morbidity and mortality; 15-40 % of patients will develop cirrhosis, liver failure, or hepatocellular carcinoma (HCC).3 The recent U.S. Institute of Medicine report highlights the need for increasing efforts in the United States to screen for, prevent, and treat HBV infection. 4 To meet this goal, it is imperative that we have a better understanding of the complex interplay between patient, provider, and health system factors limiting preventive care and progress towards HBV eradication. whose parents are from regions of high HBV endemicity, and persons with high-risk behaviors, among others. 1,5 While the 2004...

Provider, Patient, and Practice Factors Shape Hepatitis B Prevention and Management by Primary Care Providers

“…Moreover, in a previously published study of providers and patients in the San Francisco safety net, we found that provider self-report of HBV screening and immunization practices generally aligned with objective measures of clinical practice derived from electronic medical record data, adding further value to these findings. 12 The generalizability of our findings may be limited by the possible heightened awareness of HBV among providers and patients in the San Francisco bay area as a result of community outreach efforts. However, the fact that HBV prevention and management practices remained suboptimal suggests that these efforts alone do not address the gaps in HBV care and reflects a potential for even higher gaps in HBV care in other regions of the country.…”

“…11 Previously, our group has published on HBV screening practices among providers of a San Francisco safety-net health care system that serves uninsured and underinsured populations. 12–14 We showed that among APIs, less than two thirds underwent HBV testing and less than 50% of susceptible patients were vaccinated for HBV. 12 Moreover, based on self-report, over 40% of providers were unfamiliar with HBV screening guidelines.…”

“…12–14 We showed that among APIs, less than two thirds underwent HBV testing and less than 50% of susceptible patients were vaccinated for HBV. 12 Moreover, based on self-report, over 40% of providers were unfamiliar with HBV screening guidelines. 13 …”

Application of the Extended Health Control Belief Model to Predict Hepatitis A and B Vaccinations

“…Background U.S. rates of the hepatitis A virus (HAV) and hepatitis B virus (HBV) have been steadily dropping since the introduction of the HAV and HBV vaccines in 1995 and 1982, respectively (Bondesson & Saperston, 1996); however, vaccination coverage in adults for vaccine-preventable diseases is still low for most routinely recommended vaccinations (Williams et al, 2015). Currently, adults who may be traveling to HAV or HBV endemic areas, those who have had or who are at risk for contracting sexually transmitted infections (STIs), inmates in correctional facilities, and members of medically underserved Asian groups are recommended to receive vaccination against hepatitis A and B (Keystone, 2009;Mukhtar et al, 2015). Furthermore, HBV has been identified as a public health problem for homeless individuals (Nyamathi et al, 2015), injection drug users (Kamath, Shah, & Hwang, 2014), and adults living in skilled nursing facilities (Annunziata, Rak, Del Buono, DiBonaventura, & Krishnarajah, 2012).…”

Capsule Commentary on Mukhtar et al., Assessment of HBV Preventive Services in a Medically Underserved Asian and Pacific Islander Population Using Provider and Patient Data

“…1,2 The study by Mukhtar and colleagues highlights some of the barriers to hepatitis B screening. 3 Not surprisingly, testing rates for hepatitis B were positively associated with provider attitudes and negatively associated with providers' perceived barriers to testing. Notably, provider knowledge was not associated with testing.…”