Assessment of HBV preventive services in a medically underserved Asian and Pacific Islander population using provider and patient data

Autor: Tung T. Nguyen, Hali Hammer, Alice Hm Chen, Peter Berman, Mandana Khalili, Nizar A. Mukhtar, Daniel Chan, Brian C. Toy, Blaire E. Burman, Charles E. McCulloch, Albert C. H. Yu
Rok vydání: 2015
Předmět:
Male
Native Hawaiian or Other Pacific Islander
Medically Underserved Area
Safety net
Logistic regression
California
Hepatitis
Mass Screening
Young adult
Original Research
education.field_of_study
Traditional medicine
Medical record
Liver Disease
Vaccination
Professional Practice
Hepatitis B
Middle Aged
Health Services
Asians
Pacific islanders
Female
Clinical Competence
Patient Safety
Adult
medicine.medical_specialty
Population
Clinical Sciences
Health Promotion
Hawaii
Vaccine Related
Hepatitis - B
HBV prevention
Young Adult
Clinical Research
HBV screening
General & Internal Medicine
Behavioral and Social Science
Internal Medicine
medicine
Humans
Hepatitis B Vaccines
education
Mass screening
Aged
HBV vaccination
Primary Health Care
Asian
business.industry
Prevention
Capsule Commentary
medicine.disease
Good Health and Well Being
Asian Americans
Family medicine
Immunization
business
Digestive Diseases
Zdroj: Journal of general internal medicine, vol 30, iss 1
Popis: BackgroundHepatitis 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.ObjectiveThe purpose of this study was to evaluate HBV screening and vaccination practices using both provider self-report and patient records.DesignMedical 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.ParticipantsThe study included primary care providers and their adult API patients in the San Francisco safety-net healthcare system.Main measuresPatient, 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 resultsThe 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).ConclusionsRates 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.
Databáze: OpenAIRE
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