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Comparative Study
. 2014 Jan-Mar;23(1):1-9.
doi: 10.1097/QMH.0000000000000007.

Physician nonadherence with a hepatitis C screening program

William N Southern  1 , Mari-Lynn Drainoni, Bryce D Smith, Elisa Koppelman, M Diane McKee, Cindy L Christiansen, Allen L Gifford, Cindy M Weinbaum, Alain H Litwin
Affiliations
Comparative Study

Physician nonadherence with a hepatitis C screening program

William N Southern et al. Qual Manag Health Care. 2014 Jan-Mar.

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.

Subjects and 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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Hepatitis C screening.
Figure 2
Figure 2
Variation in screening among physicians.
Figure 3
Figure 3
(A) Fraction screened each study week. (B) Fraction screened each study stratified by physician quartile.
Figure 4
Figure 4
Proportion of elevated alanine transaminase levels correctly identified on screener.
See this image and copyright information in PMC

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