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Assessment of HBV Preventive Services in a Medically Underserved Asian and Pacific Islander Population Using Provider and Patient Data

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ABSTRACT

Background

Hepatitis B (HBV) represents a significant health disparity among medically underserved Asian and Hawaiian/Pacific Islander (API) populations. Studies evaluating adherence to HBV screening and vaccination guidelines in this population are limited.

Objective

The purpose of this study was to evaluate HBV screening and vaccination practices using both provider self-report and patient records.

Design

Medical records for 20,574 API adults were reviewed retrospectively and primary care providers were surveyed to evaluate rates and adherence to HBV screening and vaccination guidelines.

Participants

The study included primary care providers and their adult API patients in the San Francisco safety-net healthcare system.

Main Measures

Patient, practice, and provider factors, as well as HBV screening and vaccination practices, were assessed using provider survey constructs and patient laboratory and clinical data. Generalized linear mixed models and multivariate logistic regression analyses were used to identify factors associated with recommended HBV screening and vaccination.

Key Results

The mean age of patients was 52 years, and 63.4 % of patients were female. Only 61.5 % underwent HBV testing, and 47.4 % of HBV-susceptible patients were vaccinated. Of 148 (44.8 %) responding providers, most were knowledgeable and had a favorable attitude towards screening, but 43.2 % were unfamiliar with HBV guidelines. HBV screening was positively associated with favorable provider attitude score (OR per unit 1.80, 95 % CI 1.18–2.74) and negatively associated with female patient sex (OR 0.82, 95 % CI 0.73–0.92), a higher number of clinic patients per week (OR per 20 patients 0.46, 95 % CI 0.28–0.76), and provider barrier score (OR per unit 0.45, 95 % CI 0.24–0.87). HBV vaccination was negatively associated with provider barrier score (OR per unit 0.48, 95 % CI 0.25–0.91).

Conclusions

Rates of HBV screening and vaccination of API patients in this safety-net system are suboptimal, and provider factors play a significant role. Efforts to cultivate positive attitudes among providers and expand healthcare system resources to reduce provider barriers to HBV care are warranted.

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Acknowledgments

Funders

This work was in part supported by San Francisco General Hospital Foundation Grant (M.K.), K24AA022523 (M.K.), and P30 DK026743 (UCSF Liver Center).

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Nizar A. Mukhtar MD, Brian C. Toy MD, Blaire E. Burman MD, Alice Hm Chen MD, Tung Nguyen MD & Mandana Khalili MD

  2. Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA

    Albert Yu MD, Peter Berman MD & Hali Hammer MD

  3. Liver Center, University of California, San Francisco, San Francisco, CA, USA

    Mandana Khalili MD

  4. North East Medical Services, San Francisco, CA, USA

    Daniel Chan MD

  5. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Charles E. McCulloch PhD

  6. San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, NH-3D, San Francisco, CA, 94110, USA

    Mandana Khalili MD

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  1. Nizar A. Mukhtar MD
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  2. Brian C. Toy MD
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  7. Tung Nguyen MD
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  11. Mandana Khalili MD
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Corresponding author

Correspondence to Mandana Khalili MD.

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Mukhtar, N.A., Toy, B.C., Burman, B.E. et al. Assessment of HBV Preventive Services in a Medically Underserved Asian and Pacific Islander Population Using Provider and Patient Data. J GEN INTERN MED 30, 68–74 (2015). https://doi.org/10.1007/s11606-014-3057-9

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  • DOI: https://doi.org/10.1007/s11606-014-3057-9

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