Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA.
Division of Gastroenterology, University of Washington, Seattle, WA, USA.
J Gen Intern Med. 2022 Oct;37(13):3242-3250. doi: 10.1007/s11606-021-07232-3. Epub 2022 Jan 6.
There are few studies to date of interventions to increase viral hepatitis screening among Asian Americans, who have high rates of chronic hepatitis B (HBV) infection.
To develop, implement, and test the efficacy of a mobile application (Hepatitis App) delivered in four languages to increase HBV screening among Asian Americans.
Cluster-randomized clinical trial.
Four hundred fifty-two Asian American patients ≥ 18 years of age, who had no prior HBV testing, and received primary care within two healthcare systems in San Francisco, CA.
The intervention group received the Hepatitis App, delivering interactive video education on viral hepatitis in English, Cantonese, Mandarin, or Vietnamese and a provider printout (Provider Alert) and Provider Panel Notification. The comparison group received a mobile application delivering nutrition and physical activity education and Provider Panel Notification.
Primary outcomes were patient-provider discussion about HBV and documentation of a HBV screening test within 3 months post-intervention. Secondary outcome was documentation of an order for a HBV screening test.
Participants had a mean age of 57 years and were 64% female, 80% foreign-born, and 44% with limited English fluency. At post-visit, over 80% of intervention participants reported they liked using the Hepatitis App. At 3-month follow-up, the intervention group was more likely than the comparison group (all P < 0.001) to have discussed HBV with their provider (70% vs.16%), have a HBV test ordered (44% vs.10%), and receive a HBV test (38% vs.8%). In multivariable analyses, the intervention odds ratio for HBV test ordering was 7.6 (95% CI: 3.9, 14.8) and test receipt was 7.5 (95% CI: 3.6, 15.5).
A multi-lingual educational intervention using a mobile application in primary care clinics was well received by Asian American patients, enhanced patient-provider communication about HBV, and increased HBV screening. Technology can improve healthcare quality among Asian Americans.
ClinicalTrials.gov NCT02139722 ( https://clinicaltrials.gov/ct2/show/NCT02139722 ).
目前针对亚裔美国人的病毒性肝炎筛查干预措施研究较少，而亚裔美国人乙型肝炎病毒（HBV）慢性感染率较高。
开发、实施并测试一种以四种语言提供的移动应用程序（Hepatitis App，肝炎应用程序），以增加亚裔美国人的 HBV 筛查率。
整群随机临床试验。
452 名年龄≥18 岁的亚裔美国患者，他们之前没有进行过 HBV 检测，并且在加利福尼亚州旧金山的两个医疗系统内接受初级保健。
干预组患者使用 Hepatitis App 应用程序，以英语、粤语、普通话或越南语提供有关病毒性肝炎的互动视频教育以及一份给医生的打印件（Provider Alert，医生提醒）和医生提示通知。对照组患者使用提供营养和体育活动教育的移动应用程序以及医生提示通知。
主要结局是医患之间就 HBV 进行讨论以及在干预后 3 个月内记录 HBV 筛查检测。次要结局是记录 HBV 筛查检测的医嘱。
参与者的平均年龄为 57 岁，64%为女性，80%为外国出生，44%英语语言能力有限。在就诊后，超过 80%的干预组参与者表示他们喜欢使用 Hepatitis App。在 3 个月随访时，与对照组相比，干预组更有可能（所有 P<0.001）与他们的提供者讨论 HBV（70% vs.16%）、有 HBV 检测医嘱（44% vs.10%）和接受 HBV 检测（38% vs.8%）。在多变量分析中，HBV 检测医嘱的干预比值比为 7.6（95%CI：3.9，14.8），HBV 检测的接受率为 7.5（95%CI：3.6，15.5）。
在初级保健诊所中使用多语言教育性移动应用程序是一种很好的干预措施，它增强了医患之间关于 HBV 的沟通，并增加了 HBV 筛查。技术可以改善亚裔美国人的医疗保健质量。
ClinicalTrials.gov NCT02139722（https://clinicaltrials.gov/ct2/show/NCT02139722）。
