Hepatitis B management in vulnerable populations: gaps in disease monitoring and opportunities for improved care
| Autor: | Brian C. Toy, Charles E. McCulloch, Tung T. Nguyen, Peter Berman, Daniel Chan, Nizar A. Mukhtar, Albert C. H. Yu, Mandana Khalili, Alice Hm Chen, Blaire E. Burman, Hali Hammer |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Health Knowledge Attitudes Practice Physiology Cross-sectional study Hepatocellular carcinoma Practice Patterns Practice guidelines Hepatitis 7.1 Individual care needs Young adult Practice Patterns Physicians' Cancer Practice screening and diagnosis Health Knowledge Liver Disease Gastroenterology virus diseases Hepatitis B Disease monitoring Middle Aged Health Services Primary care Health equity Detection Infectious Diseases Population Surveillance Female Guideline Adherence Patient Safety 4.2 Evaluation of markers and technologies Adult medicine.medical_specialty Chronic Liver Disease and Cirrhosis Clinical Sciences Article Hepatitis - B Young Adult Clinical Research Internal medicine Environmental health medicine Humans Physicians' Gastroenterology & Hepatology business.industry Provider education Hepatology medicine.disease digestive system diseases Cross-Sectional Studies Good Health and Well Being Family medicine Attitudes San Francisco Management of diseases and conditions Health disparities business Digestive Diseases Safety-net Providers |
| Zdroj: | Digestive diseases and sciences, vol 59, iss 1 |
| Popis: | BackgroundHepatitis B (HBV) is prevalent in certain US populations and regular HBV disease monitoring is critical to reducing associated morbidity and mortality. Adherence to established HBV monitoring guidelines among primary care providers is unknown.AimsThe purpose of this study was to evaluate HBV disease monitoring patterns and factors associated with adherence to HBV management guidelines in the primary care setting.MethodsPrimary providers within the San Francisco safety net healthcare system were surveyed for HBV management practices, knowledge, attitudes, and barriers to HBV care. Medical records from 1,727 HBV-infected patients were also reviewed retrospectively.ResultsOf 148 (45 %) responding providers, 79 % reported ALT and 44 % reported HBV viral load testing every 6-12 months. Most providers were knowledgeable about HBV but 43 % were unfamiliar with HBV management guidelines. Patient characteristics included: mean age 51 years, 54 % male and 67 % Asian. Within the past year, 75 % had ALT, 24 % viral load, 21 % HBeAg tested, and 40 % of at-risk patients had abdominal imaging for HCC. Provider familiarity with guidelines (OR 1.02, 95 % CI 1.00-1.03), Asian patient race (OR 4.18, 95 % CI 2.40-7.27), and patient age were associated with recommended HBV monitoring. Provider HBV knowledge and attitudes were positively associated, while provider age and perceived barriers were negatively associated with HCC surveillance.ConclusionsComprehensive HBV disease monitoring including HCC screening with imaging were suboptimal. While familiarity with AASLD guidelines and patient factors were associated with HBV monitoring, only provider and practice factors were associated with HCC surveillance. These findings highlight the importance of targeted provider education to improve HBV care. |
| Databáze: | OpenAIRE |
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