Provider, Patient, and Practice Factors Shape Hepatitis B Prevention and Management by Primary Care Providers.
OBJECTIVE
To evaluate provider knowledge, attitudes and barriers to hepatitis B virus (HBV) care and management practices across diverse primary care settings.


BACKGROUND
Factors influencing adherence to recommended HBV screening and management guidelines are poorly defined.


METHODS
Providers across various health care settings in San Francisco were surveyed. Multivariate analyses were used to identify factors associated with recommended HBV screening, vaccination, and disease monitoring.


RESULTS
Of 277 (41.3%) responding providers, 42% reported performing HBV screening in >50% of at-risk patients, and 49%, HBV vaccination in >50% of eligible patients. Most reported appropriate monitoring of a majority of HBV-infected patients with alanine aminotransferase (79%) and HBV viral load (67%) every 6 to 12 months, but performed any hepatocellular carcinoma screening in 49%. Provider factors significantly associated with HBV screening were speaking an Asian language [odds ratio (OR), 3.27], offering HBV treatment (OR, 3.00), having >25% of Asian patients in practice (OR, 2.10), practicing in safety net settings (OR, 7.51) and having higher barrier score (OR, 0.74). Appropriate HBV monitoring was associated with provider speaking an Asian language (OR, 3.43) and provider age (OR, 0.68/decade). Hepatocellular carcinoma screening was associated with having >25% of patients speaking English as a second language (OR, 4.26) and practicing in safety net settings (OR, 0.14).


CONCLUSIONS
Rates of adherence to HBV guidelines were suboptimal irrespective of practice setting and were influenced by certain provider, patient and practice factors. This study reinforces the importance of engaging primary care providers in development, dissemination, and implementation of evidence-based HBV practice guidelines.
Departments of *Medicine ∥Family and Community Medicine §San Francisco Department of Public Health #Liver Center, University of California San Francisco †Department of Epidemiology and Biostatistics, University of California, San Francisco ‡Kaiser Permanente San Francisco Medical Center ¶North East Medical Services, San Francisco, CA.
Nizar A
NA
Mukhtar
Priya
P
Kathpalia
Joan F
JF
Hilton
Gene
G
Lau
Albert
A
Yu
Kevin
K
Grumbach
Tung T
TT
Nguyen
Daniel
D
Chan
Mandana
M
Khalili
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006509:Hepatitis B / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D012495:San Francisco