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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

Quality Management in Healthcare: January/March 2014 - Volume 23 - Issue 1 - p 1–9
doi: 10.1097/QMH.0000000000000007
Original Articles

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.

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).

Correspondence: William N. Southern, MD, MS, Division of Hospital Medicine, Department of Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467 (

The authors declare no conflicts of interest.

This project was funded by a Centers for Disease Control and Prevention (CDC) contract via the Agency Health Care Research and Quality (AHRQ) ACTION initiative to Boston University (contract HHSA2902006000012 T0#4). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ or CDC. Additional support was provided the Clinical Investigation Core of the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center, funded by the National Institutes of Health (NIH P30 AI51519), and the CTSA grant UL1 RR025750 and KL2 RR025749 and TL1 RR025748, from the National Center for Research Resources, a component of the National Institutes of Health.

© 2014Wolters Kluwer Health | Lippincott Williams & Wilkins