Laily Alfu, Duncan Robert, Gabhart Kaitlyn M, Nephew Lauren D, Christy Shannon M, Vadaparampil Susan T, Giuliano Anna R, Kasting Monica L
Department of Public Health, College of Health and Human Sciences, Purdue University, 820 Mitch Daniels Blvd, West Lafayette, IN 47907, USA.
Department of Human Development and Family Studies, College of Health and Human Sciences, Purdue University, 1202 West State St., West Lafayette, IN 47907, USA.
Prev Med Rep. 2024 Jan 9;38:102602. doi: 10.1016/j.pmedr.2024.102602. eCollection 2024 Feb.
Providers' recommendation is among the strongest predictors to patients engaging in preventive care. Therefore, the aim of this study was to compare providers' Hepatitis C Virus (HCV) screening recommendation quality between high-risk and average-risk patients to determine if providers are universally recommending HCV screening, regardless of risk behaviors. This cross-sectional survey of 284 Indiana providers in 2020 assessed provider characteristics, HCV screening recommendation practices (strength, presentation, frequency, timeliness), self-efficacy, and barriers to recommending HCV screening. T-test and Chi-square compared recommendation practices for high-risk and average-risk patients. Prevalence ratios were calculated for variables associated with HCV recommendation strength comparing high-risk and average-risk patients. Logistic regression analyses examined factors associated with HCV recommendation strength for high- and average-risk patients, with odds ratios. Compared to average-risk patients, high-risk patients received higher proportion of HCV recommendations that were strong (70.4 % v. 42.4 %), routine (61.9 % v. 55.6 %), frequent (37.7 % v. 28 %), and timely (74.2 % v. 54.9 %) (P-values < 0.001). Compared to average-risk patients, providers with high-risk patients had a lower percentage of giving a strong recommendation if they were nurse practitioner (PR = 0.49). For high-risk patients, providers with higher self-efficacy (aOR = 2.16;95 %CI = 0.99-4.69) had higher odds, while those with higher perceived barriers (aOR = 0.19;95 %CI = 0.09-0.39) and those with an internal medicine specialty compared to family medicine (aOR = 0.22;95 %CI = 0.08-0.57) had lower odds of giving a strong recommendation. These data suggest providers are not universally recommending HCV screening for all adults regardless of reported risk. Future research should translate these findings into multilevel interventions to improve HCV screening recommendations regardless of patient risk status.
医疗服务提供者的建议是患者接受预防性护理的最强预测因素之一。因此，本研究的目的是比较医疗服务提供者对高危和中危患者丙型肝炎病毒（HCV）筛查建议的质量，以确定医疗服务提供者是否普遍建议进行HCV筛查，而不考虑风险行为。这项2020年对284名印第安纳州医疗服务提供者进行的横断面调查评估了医疗服务提供者的特征、HCV筛查建议做法（力度、呈现方式、频率、及时性）、自我效能感以及推荐HCV筛查的障碍。采用t检验和卡方检验比较高危和中危患者的建议做法。计算了与HCV建议力度相关变量的患病率比，以比较高危和中危患者。逻辑回归分析检验了与高危和中危患者HCV建议力度相关的因素，并给出比值比。与中危患者相比，高危患者获得的HCV强烈建议比例更高（70.4%对42.4%）、常规建议比例更高（61.9%对55.6%）、频繁建议比例更高（37.7%对28%）以及及时建议比例更高（74.2%对54.9%）（P值<0.001）。与中危患者相比，如果医疗服务提供者是执业护士，其对高危患者给出强烈建议的比例较低（PR = 0.49）。对于高危患者，自我效能感较高的医疗服务提供者给出强烈建议的几率更高（调整后比值比[aOR]=2.16；95%置信区间[CI]=0.99 - 4.69），而感知障碍较高的医疗服务提供者（aOR = 0.19；95%CI = 0.09 - 0.39）以及与家庭医学相比具有内科专业的医疗服务提供者（aOR = 0.22；95%CI = 0.08 - 0.57）给出强烈建议的几率较低。这些数据表明，医疗服务提供者并非普遍建议所有成年人进行HCV筛查，而不考虑报告的风险。未来的研究应将这些发现转化为多层次干预措施，以改善HCV筛查建议，而不考虑患者的风险状况。
