title: Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States.
abstract: BACKGROUND
  Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. Since training for family medicine (FM) and internal medicine (IM) physicians differ, we hypothesised that there are differences in knowledge, attitudes and barriers regarding vaccination against HAV and HBV in patients with chronic HCV between these two groups.
  
  
  METHODS
  A two-page questionnaire was mailed to 3000 primary care (FM and IM) physicians randomly selected from the AMA Physician Masterfile in 2005. The survey included questions about physician demographics, knowledge and attitudes regarding vaccination.
  
  
  RESULTS
  Among the 3000 physicians surveyed, 1209 (42.2%) returned completed surveys. There were no differences between respondents and non-respondents with regard to age, gender, geographic location or specialty. More FM than IM physicians stated that HCV+ patients should not be vaccinated against HAV (23.7% vs. 11.8%, p < 0.001) or HBV (21.9% vs. 10.6%, p < 0.001). FM physicians were also less likely than IM physicians to usually/always test HCV+ patients for immunity against HAV (33.9% vs. 48.6%, p < 0.001) or against HBV (50.8% vs. 68.0%, p < 0.001). There were numerous barriers to HAV and HBV vaccination identified. The median number of barriers was 3 for FM physicians and 2 for IM physicians (p < 0.001).
  
  
  CONCLUSIONS
  Despite recommendations to vaccinate against HAV and HBV in patients with chronic HCV infection, physicians often do not test or vaccinate susceptible individuals. Interventions are needed to overcome the barriers identified and improve vaccination rates.
authors.affiliation: Division of General Internal Medicine, VA New York Harbor Healthcare System and NYU School of Medicine, New York, NY, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Tenner
authors.forename: K
authors.initials: K
authors.lastname: Herzog
authors.forename: S
authors.initials: S
authors.lastname: Chaudhari
authors.forename: E J
authors.initials: EJ
authors.lastname: Bini
authors.forename: E H
authors.initials: EH
authors.lastname: Weinshel
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006506:Hepatitis A / Q000517:prevention & control*; D022362:Hepatitis A Vaccines; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D012423:Rural Health; D011795:Surveys and Questionnaires; D014481:United States; D014504:Urban Health; D014611:Vaccination
chemical_list: D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines