美国南部非城市地区未按预约就诊人群中丙型肝炎治疗障碍的定性研究。
A qualitative study of perceived barriers to hepatitis C care among people who did not attend appointments in the non-urban US South.
机构信息
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA.
University of Virginia School of Medicine, Charlottesville, VA, USA.
出版信息
Harm Reduct J. 2020 Sep 18;17(1):64. doi: 10.1186/s12954-020-00409-9.
BACKGROUND
Most people diagnosed with hepatitis C virus (HCV) have not linked to care, despite the availability of safe and effective treatment. We aimed to understand why people diagnosed with HCV have not pursued care in the non-urban Southern United States.
METHODS
We conducted a survey and semi-structured interview with participants referred to an HCV clinic who did not attend an appointment between 2014 and 2018. Our clinic is located in a non-urban region of Virginia at a university hospital. Qualitative data collection was guided by the Health Belief Model (HBM). Data was analyzed using qualitative content analysis to identify key factors influencing patient perceptions regarding HCV and pursuit of care.
RESULTS
Over half of previously referred patients (N = 200) could not be reached by phone. Eleven participants enrolled, including 7 men and 4 women. Based on survey responses, unreliable transportation, unstable housing, substance use, and lack of insurance were common. Participants demonstrated good knowledge of HCV disease, complications, and treatment. On qualitative analysis of semi-structured interviews, final themes emerged from within and between HBM constructs. Emerging themes influencing patient perceptions included (1) structural barriers, (2) stigma, (3) prior experiences of HCV disease and treatment, (4) discordance between the recognized severity of HCV and expected impacts on one's own health, and (5) patient-provider relationship. Substance use was not identified to be a barrier to care.
CONCLUSIONS
Participants perceived individual and structural barriers to linking to care. A strong HCV knowledge base was not sufficient to motivate pursuit of care. Efforts to improve linkage to care must address barriers at multiple levels, and system-level changes are needed. As the majority of previously referred patients could not be contacted by phone, current approaches to patient engagement are not effective for reaching these populations. Expansion of HCV care to primary care settings with an established patient-provider relationship or co-located treatment within substance use treatment programs may serve to increase access to HCV treatment.
背景
尽管已有安全有效的治疗方法，但大多数被诊断患有丙型肝炎病毒 (HCV) 的人并未寻求治疗。本研究旨在了解美国南部非城市地区为何有那么多被诊断患有 HCV 的人不寻求治疗。
方法
我们对 2014 年至 2018 年间未到 HCV 诊所就诊的患者进行了调查和半结构式访谈。我们的诊所位于弗吉尼亚州一个非城市地区的大学医院。定性数据收集以健康信念模型 (HBM) 为指导。使用定性内容分析来识别影响患者对 HCV 及其治疗的看法的关键因素，对数据进行分析。
结果
在之前转介的患者中，超过一半（N=200）无法通过电话联系到。有 11 名参与者入组，包括 7 名男性和 4 名女性。根据调查结果，交通不便、住房不稳定、药物滥用和缺乏保险是常见问题。参与者对 HCV 疾病、并发症和治疗方法有很好的了解。通过对半结构式访谈的定性分析，从 HBM 结构内和之间出现了一些主题。影响患者看法的主题包括：（1）结构性障碍，（2）污名，（3）对 HCV 疾病和治疗的先前经历，（4）HCV 严重程度的公认程度与对自身健康影响的预期之间的差异，以及（5）医患关系。药物滥用未被确定为寻求治疗的障碍。
结论
参与者认为存在个体和结构性障碍，无法寻求治疗。对 HCV 的深入了解不足以激发他们寻求治疗。必须在多个层面上努力解决阻碍治疗的问题，需要进行系统层面的变革。由于大多数之前转介的患者无法通过电话联系，目前的患者参与方法对这些人群效果不佳。将 HCV 护理扩展到有患者-医生关系的初级保健机构或在药物滥用治疗项目中提供治疗，可能有助于增加 HCV 治疗的可及性。
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