Grannan S
Willow Creek Family Practice, 4003 Rawlins Street, Cheyenne, WY, 82001.
J Viral Hepat. 2017 Aug;24(8):631-635. doi: 10.1111/jvh.12692. Epub 2017 Apr 5.
The specific aims were to identify specific themes and barriers to viral hepatitis C (HCV) testing and to determine if testing rates increased when patients self-identify their risk factors and were offered testing. This study was conducted at a Federally Qualified Health Centre (FQHC) in an underserved neighbourhood located in the Mountain West. This descriptive study used survey and group-level electronic health record (EHR) data. Adults 18 years and older who speak and write in English or Spanish and arrived for care at a FQHC were recruited to complete a survey. The 10-item survey assessed demographics, HCV risk, willingness to test, and reasons for not testing. Screening rates during the survey period were compared with the baseline 2014 rates using EHR data. EHR demographic, testing, and incidents of positive HCV infections data were analysed and compared with survey data. The typical participant (N=111) was female (74%), Baby Boomer (1945-1965) generation (45%), white (86%), and uninsured (54%). Top 6 self-identified risks were tattoo and/or body piercings (47.7%), Baby Boomer (36%), multiple sex partners (18%), work-related exposure (8.1%), non-injection drug use (8.1%), and injection drug use (7.2%). Only 78% of Baby Boomers identified being a Baby Boomer as a risk. Eighty-one percent of participants did not want to test. Testing did not increase during the study period (2.9 tests/wk in 2014 and 2.1 tests/wk during the survey period). Main reasons not to test were "I do not have any risk factors" (30.2%), concerned with cost (15.1%), tested in the past (15.1%), other reasons (9.3%), not feeling well (5.8%). More than one main reason was selected by 17% of the participants. Baby Boomers did not self-identify risk. Also, testing incidence did not increase when patients self-identified risk and were offered testing. Many participants did not identify risk which is a barrier to testing.Additional barriers to overcome are concerns with cost and comfort in the clinical setting.
具体目标是确定丙型病毒性肝炎（HCV）检测的特定主题和障碍，并确定当患者自我识别其风险因素并接受检测时检测率是否会提高。本研究在位于美国西部山区一个服务不足社区的联邦合格健康中心（FQHC）进行。这项描述性研究使用了调查数据和群体层面的电子健康记录（EHR）数据。招募了18岁及以上、能说英语或西班牙语并前往FQHC就诊的成年人来完成一项调查。这份包含10个项目的调查评估了人口统计学特征、HCV风险、检测意愿以及不进行检测的原因。使用EHR数据将调查期间的筛查率与2014年的基线率进行比较。对EHR中的人口统计学、检测以及HCV感染阳性事件数据进行了分析，并与调查数据进行比较。典型参与者（N = 111）为女性（74%）、婴儿潮一代（1945 - 1965年出生）（45%）、白人（86%）且未参保（54%）。自我识别出的前六大风险是纹身和/或穿孔（47.7%）、婴儿潮一代（36%）、多个性伴侣（18%）、工作相关暴露（8.1%）、非注射吸毒（8.1%）以及注射吸毒（7.2%）。只有78%的婴儿潮一代将自己归为婴儿潮一代作为一种风险因素。81%的参与者不想接受检测。在研究期间检测率没有提高（2014年为每周2.9次检测，调查期间为每周2.1次检测）。不进行检测的主要原因是“我没有任何风险因素”（30.2%）、担心费用（15.1%）、过去已检测过（15.1%）、其他原因（9.3%）、感觉不舒服（5.8%）。17%的参与者选择了不止一个主要原因。婴儿潮一代没有自我识别风险。此外，当患者自我识别风险并接受检测时，检测发生率并未提高。许多参与者没有识别出风险，这是检测的一个障碍。需要克服的其他障碍是对费用的担忧以及临床环境中的舒适度问题。
