Skip Navigation LinksHome > January/March 2014 - Volume 23 - Issue 1 > Physician Nonadherence With a Hepatitis C Screening Program
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Quality Management in Health Care:
doi: 10.1097/QMH.0000000000000007
Original Articles

Physician Nonadherence With a Hepatitis C Screening Program

Southern, William N. MD, MS; Drainoni, Mari-Lynn PhD; Smith, Bryce D. PhD, MSSW; Koppelman, Elisa MSW, MPH; McKee, M. Diane MD, MS; Christiansen, Cindy L. PhD; Gifford, Allen L. MD; Weinbaum, Cindy M. MD, MPH; Litwin, Alain H. MD, MPH, MS

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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.

© 2014Wolters Kluwer Health | Lippincott Williams & Wilkins

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