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

Abstract

Goals To evaluate provider knowledge, attitudes and barriers to HBV care and management practices across diverse primary care settings. Background Factors influencing adherence to recommended hepatitis B virus (HBV) screening and management guidelines are poorly defined. Methods Providers across various healthcare 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 ALT (79%) and HBV viral load (67%) every 6–12 months, but performed any hepatocellular carcinoma (HCC) screening in 49%. Provider factors significantly associated with HBV screening were speaking an Asian language (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). HCC 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.

Liver Disease Monitoring Practices After Hepatitis C Cure in the Underserved Population

“…Within our own health care system, a prior study found that 51% of patients with chronic hepatitis B had received HCC screening within the year . The rate of 20% without HCC screening in this HCV cohort, however, is higher than reported (10.2%) among patients with HBV …”

“…(21) The rate of 20% without HCC screening in this HCV cohort, however, is higher than reported (10.2%) among patients with HBV. (22) While we did not identify any particular factor that was significantly related to the lack of timely clinic visits or laboratory testing, the presence of cirrhosis was associated with receiving timely HCC screening among patients with advanced fibrosis. Further studies are needed to evaluate the role of other unmeasured patient and any provider factors contributing to the lack of optimal monitoring post-SVR in HCV.…”

“…Indeed, provider knowledge has been independently associated with suboptimal monitoring of patients in chronic HBV. (21,22) Collectively, these data suggest that adherence to disease monitoring guidelines in viral hepatitis is suboptimal, and interventions including patient and provider education along with enhanced access to care and reduced barriers are likely needed to address these gaps.…”

Evaluation of Hepatitis B Virus Screening, Vaccination, and Linkage to Care Among Newly Arrived Refugees in Four States, 2009–2011

“…The overall prevalence of HBsAg was 2.9% among refugees, representing an approximately 10 times higher burden of HBV infection than seen in the general U.S. population [3], confirming the need for early diagnosis and management of HBV infection among newly arriving refugees. Given the underdiagnosis of HBV infection by U.S. providers [22, 23], the refugee domestic health assessment is a key opportunity for early detection and prevention of HBV-related morbidity and mortality.…”

Junior Doctors’ Knowledge about Chronic Hepatitis B Guideline: A Survey Among 30 Primary Hospitals in Sichuan Province of China

“…In real-life clinical practice, the diagnosis and treatment options of diseases are largely determined by the physicians; so, the level of primary physician's knowledge, training, and practice is closely related to the quality of medical services (6). Thus, this questionnaire-based survey was designed to assess the knowledge of junior doctors on the 2015 CHB guideline recommended by Chinese society of infectious diseases and Chinese society of hepatology, Chinese medical association.…”