Falade-Nwulia O, McAdams-Mahmoud A, Irvin R, Niculescu A, Page K R, Mix M, Thomas D L, Sulkowski M S, Mehta S H
Johns Hopkins University School of Medicine, Baltimore, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
J Community Med Health Educ. 2016 Oct;6(5). doi: 10.4172/2161-0711.1000481. Epub 2016 Oct 28.
There are over 3 million Americans infected with hepatitis C virus (HCV). Despite recent advances in HCV treatment, a major barrier to care remains a limited number of treaters. HCV therapy provision by primary care providers (PCPs) could expand access by increasing the pool of HCV treating clinicians.
To characterize current HCV care practices, willingness and self-efficacy of PCPs to become HCV treaters.
Two hundred and seventy one PCPs were identified from community clinics affiliated with a large academic center and 4 large federally qualified health centers in Baltimore, MD. An internet-based survey was administered to assess provider demographics, clinical practice site and willingness to provide HCV care. Factors associated with willingness to provide HCV care were examined using odds ratios (OR).
Among 129 (48%) PCPs who responded, the majority (70%) had an MD/DO degree and were white (60%). Only a few PCPs, 12 (10%), had treated at least 1 patient for HCV in the prior year. Although only 22% agreed that HCV treatment should be provided by PCPs, 84% were interested in more HCV training. Willingness to provide treatment was strongly linked to having a high proportion of HCV-infected patients (>20% versus <20%; OR 3.9; 95% confidence interval [CI] 1.5-10) and availability of other services at the primary care site including HIV treatment (OR 6.5; 95% CI 2.5-16.5), substance abuse treatment (OR 3.3; 95% CI 1.3-8.4) and mental health services (OR 4.9; 95% CI 2.0-12.1).
These data suggest that efforts to expand HCV medical provider capacity will be most impactful if they initially focus HCV training on PCPs with a high prevalence of HCV among their patients and existing systems to support HCV care.
超过300万美国人感染了丙型肝炎病毒（HCV）。尽管HCV治疗最近取得了进展，但护理的一个主要障碍仍然是治疗人员数量有限。初级保健提供者（PCP）提供HCV治疗可以通过增加HCV治疗临床医生的数量来扩大治疗机会。
描述当前HCV护理实践、PCP成为HCV治疗者的意愿和自我效能。
设计、参与者和主要测量方法：从与一个大型学术中心相关的社区诊所和马里兰州巴尔的摩的4个大型联邦合格健康中心中确定了271名PCP。进行了一项基于互联网的调查，以评估提供者的人口统计学特征、临床实践地点以及提供HCV护理的意愿。使用优势比（OR）检查与提供HCV护理意愿相关的因素。
在129名（48%）做出回应的PCP中，大多数（70%）拥有医学博士/医学博士学位且为白人（60%）。在前一年，只有少数PCP，即12名（10%），治疗过至少1名HCV患者。尽管只有22%的人同意应由PCP提供HCV治疗，但84%的人对更多的HCV培训感兴趣。提供治疗的意愿与HCV感染患者比例高（>20%对<20%；OR 3.9；95%置信区间[CI] 1.5 - 10）以及初级保健地点提供包括HIV治疗（OR 6.5；95% CI 2.5 - 16.5）、药物滥用治疗（OR 3.3；95% CI 1.3 - 8.4）和心理健康服务（OR 4.9；95% CI 2.0 - 12.1）等其他服务密切相关。
这些数据表明，如果最初将HCV培训重点放在其患者中HCV患病率高的PCP以及现有的支持HCV护理的系统上，那么扩大HCV医疗提供者能力的努力将最有成效。
