Factors affecting adherence to HBV guidelines
Regardless of practice setting, the rates of adherence to hepatitis B virus (HBV) guidelines are unsatisfactory and influenced by several provider, patient and practice factors, reports a study.
To assess provider knowledge, attitudes and barriers to HBV care and management practices, researchers surveyed providers across various healthcare settings in San Francisco, USA. They used multivariate analyses to identify factors related to recommended HBV screening, vaccination and disease monitoring.
A total of 277 providers responded to the survey. Of these, 42 percent reported performing HBV screening in >50 percent of at-risk patients and 49 percent reported performing HBV vaccination in >50 percent of eligible patients.
Most providers reported appropriate monitoring of a majority of HBV-infected patients with alanine aminotransferase (79 percent) and HBV viral load (67 percent) every 6 to 12 months. However, hepatocellular carcinoma screening was performed only in 49 percent.
HBV screening was significantly associated with the following provider factors: speaking an Asian language (odds ratio [OR], 3.27), offering HBV treatment (OR, 3.00), having >25 percent of Asian patients in practice (OR, 2.10), practicing in safety net settings (OR, 7.51) and having higher barrier score (OR, 0.74). In addition, provider factors associated with appropriate HBV monitoring were speaking an Asian language (OR, 3.43) and age (OR, 0.68/decade).
Hepatocellular carcinoma screening correlated with having >25 percent of patients speaking English as a second language (OR, 4.26) and practicing in safety net settings (OR, 0.14).
“This study reinforces the importance of engaging primary care providers in development, dissemination and implementation of evidence-based HBV practice guidelines,” researchers said.