title: Physician nonadherence with a hepatitis C screening program.
abstract: BACKGROUND
  Testing for patients at risk for hepatitis C virus (HCV) infection is recommended, but it is unclear whether providers adhere to testing guidelines. We aimed to measure adherence to an HCV screening protocol during a multifaceted continuous intervention.
  
  
  METHODS
  Prospective cohort design to examine the associations between patient-level, physician-level, and visit-level characteristics and adherence to an HCV screening protocol. Study participants included all patients with a visit to 1 of the 3 study clinics and the physicians who cared for them. Adherence to the HCV screening protocol and patient-level, physician-level, and visit-level predictors of adherence were measured.
  
  
  RESULTS
  A total of 8981 patients and 154 physicians were examined. Overall protocol adherence rate was 36.1%. In multivariate analysis, patient male sex (odds ratio [OR] = 1.18), new patient (OR = 1.23), morning visit (OR = 1.32), and patients' preferred language being non-English (OR = 0.87) were significantly associated with screening adherence. There was a wide variation in overall adherence among physicians (range, 0%-92.4%). Screening adherence continuously declined from 59.1% in week 1 of the study to 13.7% in week 15 (final week). When implementing complex clinical practice guidelines, planners should address physician attitudinal barriers as well as gaps in knowledge to maximize adherence.
authors.affiliation: Department of Medicine (Drs Southern and Litwin), Division of Hospital Medicine (Dr Southern), Division of General Internal Medicine (Dr Litwin), and Department of Family and Social Medicine (Dr McKee), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York; Department of Health Policy & Management, Boston University School of Public Health, Boston, Massachusetts (Drs Drainoni, Christiansen, and Gifford and Ms Koppelman); Department of Medicine (Drs Drainoni and Gifford), Division of General Internal Medicine (Dr Gifford), Section of Infectious Diseases (Dr Drainoni), Boston University School of Medicine, Boston, Massachusetts; Center for Health Quality, Outcomes and Economic Research, ENRM Veterans Administration Hospital, Bedford, Massachusetts (Drs Drainoni, Christiansen, and Gifford and Ms Koppelman); and Division of Viral Hepatitis, National Center for HIV/Viral Hepatitis/STD/TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Smith and Weinbaum).
authors.forename: William N
authors.initials: WN
authors.lastname: Southern
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
authors.forename: Elisa
authors.initials: E
authors.lastname: Koppelman
authors.forename: M Diane
authors.initials: MD
authors.lastname: McKee
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Christiansen
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Weinbaum
authors.forename: Alain H
authors.initials: AH
authors.lastname: Litwin
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000592:standards / Q000639:trends; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult