ASPO Abstracts
“The Patients Aren’t the Problemâ€: An Examination of Multilevel Barriers to Hepatitis C Virus Screening among Baby Boomers in Primary Care
Category: Early Detection & Risk Prediction
Conference Year: 2019
Abstract Body:
Purpose: Liver cancer rates are rising and hepatitis C virus (HCV) is the primary cause. The CDC recommends a one-time HCV screening for all persons born 1945-1965 (baby boomers). However, 14% of baby boomers have been screened. Few studies have examined primary care physicians’ (PCP) perspectives on barriers to HCV screening.Methods: We conducted a mixed methods pilot study of PCPs. Qualitative: We conducted interviews assessing patient, provider, and clinic-level barriers to HCV screening for baby boomers in primary care. Interviews were audio recorded, transcribed, and analyzed with content analysis. Quantitative: We surveyed PCPs from 3 different health systems assessing multilevel barriers, recommendation quality (strong, consistent, urgent), self-efficacy to identify and treat HCV (range:0-4), and knowledge (range:0-10). Results: Qualitative (n=9): Participants were 56% female, 67% White, and averaged 11.0 years in practice. Most PCPs noted barriers to screening were not at the patient-level stating, “The patients aren’t the problem.” The most common barrier was lack of time to discuss HCV screening. PCPs also reported high patient screening recommendation awareness due to media coverage. Quantitative (n=16): Data collection is ongoing, and here we report responses collected as of 10-31-18. Participants were 56% female, 69% White, and averaged of 11.3 years in practice. Most (81%) were aware of screening recommendations, but only 19% reported recommending screening almost always. All participants indicated they present HCV screening as routine and 69% strongly recommend it. In contrast to qualitative results, only 6% reported lack of time as a barrier. Most (75%) agreed HCV was less urgent than patients’ other problems. Perceived self-efficacy was high (M=2.3), and participants averaged 8.3/10 knowledge questions correct. While most PCPs correctly answered questions about modes of transmission, 63% incorrectly stated people infected with HCV carry the virus for life. Conclusion: Results from this study demonstrate PCPs had high HCV-related knowledge and self-efficacy. Data collection is ongoing and results will be used to address reported barriers to screening including competing demands on time during the clinic visit.
Keywords: Hepatitis C; cancer screening; early detection