title: Screening high risk individuals for hepatitis B: physician knowledge, attitudes, and beliefs.
abstract: BACKGROUND
  Although the overall incidence of hepatitis B virus (HBV) has declined since the introduction of universal vaccine guidelines, the incidence remains elevated in high risk groups. Recent guidelines from the Centers for Disease Control (CDC) have underscored the importance of vaccination against HBV in high risk individuals. However, the incidence of HBV in this group remains elevated, suggesting underuse of vaccinations by healthcare providers.
  
  
  OBJECTIVE
  The purpose of this study was to measure practice patterns of HBV vaccination, and identify predictors of vaccination underuse.
  
  
  METHODS
  We created a survey with four vignettes describing patients at high risk for contracting HBV, followed by questions regarding knowledge, attitudes, and beliefs (KAB) of HBV screening and vaccination. A random sample of 1,000 physicians, including internists, family medicine, OB/GYN, gastroenterologists, and experts in HBV epidemiology were surveyed. Regression analysis on composite guideline adherence scores identified KAB profiles that predict scores.
  
  
  RESULTS
  On average, responders endorsed 71% of the CDC HBV vaccination guidelines. There were three predictors of diminished screening proclivity: (1) younger provider age (P = 0.028), (2) lower awareness that adult HBV is contracted primarily through heterosexual sex (P = 0.023), and (3) being a provider other than a gastroenterologist (P = 0.009).
  
  
  CONCLUSIONS
  Respondents endorsed most-but not all-CDC supported HBV screening practices. Lower adherence was predicted by specific and modifiable KAB profiles, and by younger age. Future efforts to improve adherence should target trainees, emphasize the importance of obtaining sexual histories in high risk patients, and inform that HBV is predominantly a heterosexually transmitted infection.
authors: Division of Digestive Diseases, Emory University School of Medicine, 49 Jesse Hill Jr. Dr. S.E. Rm 437, Atlanta, GA 30303, USA. tyfoste@emory.edu
authors: Temitope
authors: T
authors: Foster
authors: Huiming
authors: H
authors: Hon
authors: Fasiha
authors: F
authors: Kanwal
authors: Steven
authors: S
authors: Han
authors: Brennan
authors: B
authors: Spiegel
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006509:Hepatitis B / Q000453:epidemiology* / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000592:standards*
chemical_list: D017325:Hepatitis B Vaccines