Department of Public Health, Purdue University, 812 W. State Street, West Lafayette, IN, 47907, USA.
Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
BMC Fam Pract. 2020 Dec 2;21(1):248. doi: 10.1186/s12875-020-01327-2.
Liver cancer rates are rising and hepatitis C virus (HCV) is the primary cause. The CDC recommends a one-time HCV screening for all persons born 1945-1965 (baby boomers). However, 14% of baby boomers have been screened. Few studies have examined primary care providers' (PCP) perspectives on barriers to HCV screening. This study examines current HCV screening practices, knowledge, barriers, and facilitators to HCV screening recommendation for baby boomers among PCPs.
We conducted a mixed methods pilot study of PCPs. Quantitative: We surveyed PCPs from 3 large academic health systems assessing screening practices, knowledge (range:0-9), self-efficacy to identify and treat HCV (range:0-32), and barriers (range:0-10). Qualitative: We conducted interviews assessing patient, provider, and clinic-level barriers to HCV screening for baby boomers in primary care. Interviews were audio recorded, transcribed, and analyzed with content analysis.
The study sample consisted of 31 PCPs (22 survey participants and nine interview participants). All PCPs were aware of the birth cohort screening recommendation and survey participants reported high HCV testing recommendation, but qualitative interviews indicated other priorities may supersede recommending HCV testing. Provider knowledge of viral transmission was high, but lower for infection prevalence. While survey participants reported very few barriers to HCV screening in primary care, interview participants provided a more nuanced description of barriers such as lack of time.
There is a need for provider education on both HCV treatment as well as how to effectively recommend HCV screening for their patients. As HCV screening guidelines continue to expand to a larger segment of the primary care population, it is important to understand ways to improve HCV screening in primary care.
肝癌发病率正在上升，丙型肝炎病毒（HCV）是主要病因。美国疾病控制与预防中心（CDC）建议对所有 1945 年至 1965 年出生的人群（婴儿潮一代）进行一次性 HCV 筛查。然而，只有 14%的婴儿潮一代接受了筛查。很少有研究调查初级保健提供者（PCP）对 HCV 筛查障碍的看法。本研究调查了 PCP 对婴儿潮一代 HCV 筛查的现行筛查实践、知识、障碍和促进因素。
我们对 PCP 进行了一项混合方法的试点研究。定量研究：我们调查了来自 3 家大型学术医疗系统的 PCP，评估了他们的筛查实践、知识（范围：0-9）、识别和治疗 HCV 的自我效能（范围：0-32），以及障碍（范围：0-10）。定性研究：我们进行了访谈，评估了婴儿潮一代在初级保健中 HCV 筛查的患者、提供者和诊所层面的障碍。访谈进行了录音、转录，并采用内容分析法进行分析。
研究样本包括 31 名 PCP（22 名调查参与者和 9 名访谈参与者）。所有 PCP 都意识到了这一出生队列筛查建议，调查参与者报告了高 HCV 检测推荐率，但定性访谈表明，其他优先事项可能会取代 HCV 检测建议。提供者对病毒传播的了解程度较高，但对感染流行率的了解程度较低。虽然调查参与者报告在初级保健中 HCV 筛查几乎没有障碍，但访谈参与者提供了更细致的描述，如缺乏时间。
需要对提供者进行 HCV 治疗以及如何有效为其患者推荐 HCV 筛查的教育。随着 HCV 筛查指南继续扩大到更多的初级保健人群，了解如何在初级保健中提高 HCV 筛查的方法非常重要。
