Clinician type

1. Are primary care clinicians knowledgeable about screening for chronic hepatitis B infection? Maya Dulay, MD1, Janet Zola, MPH2, Jimmy Hwang, PhD1, Robert Baron, MD1, Cindy Lai, MD1 1University of California San Francisco School of Medicine - Division of General Internal Medicine 2San Francisco Department of Public Health 35% 32% 40% 35% 23% 30% 25% 20% 7% 15% 3% 10% 5% Stronglydisagree Disagree Neutral Stronglyagree Agree 0% BACKGROUND DEMOGRAPHICS RESULTS Age median = 49 years range = 27-76 years Gender women = 54% Clinical experience median = 21 years range = 0-51 years • 350 million people have chronic hepatitis B virus (HBV) worldwide • 1.25 million people have chronic HBV in USA, with 60,000 new cases/yr • HBV is one of the greatest health disparities between Asian Americans and Caucasian Americans • 10-14% of Chinese immigrants have chronic HBV • Chinese Americans are 6 times more likely to die of liver cancer • Many at risk individuals are not screened for HBV despite interacting with healthcare providers • 33% of Vietnamese reported previous MD recommendation for HBV testing despite 78% having a regular health care • Early detection of chronic HBV infection and adequate vaccination and treatment can prevent cirrhosis, liver cancer and early death • Clinicians overestimate the relative prevalence of chronic HBV • Physicians incorrectly identified individuals with HIV (40%), men who have sex with men (41%), and injecting drug users (60%) as having a higher prevalence of chronic HBV than Chinese immigrants • Average knowledge score = 10.6 (± 2.2) • Physicians higher than non-physicians (11.0 vs. 9.8, p<0.001) Clinician type Ethnicity 80% 70% Asian American Latino 70% 13% 7% 60% AfricanAmerican 50% 1% 40% 30% 14% Factors associated with knowledge of correct screening test 10% 20% Caucasian 3% 10% 79% 0% MDs PAs NPs Nurses RESULTS Response Rate n=196 78% PURPOSE • It is unknown if primary care providers (PCPs) have adequate knowledge to properly screen for and manage chronic HBV • Determine PCPs’ knowledge of basic HBV facts and guidelines Clinicians’ confidence in their knowledge about HBV screening ONLY 45% of clinicianscorrectly chose HBsAg as the screening test of choice for chronic HBV MATERIALS AND METHODS • A multiple-choice HBV knowledge survey (pretested on non-eligible providers): • How and who to screen for chronic HBV (6 questions) • Chronic HBV management (3 questions) • HBV prevalence in different at risk populations (5 questions) • Study population: attendees of a university-based CME conference • Primary outcomes: • Proportion reporting the correct screening test for chronic HBV (hepatitis B surface antigen [HBsAg]) • Knowledge score: sum of number of correct responses (min 0, max 14) • Statistical analysis: • Bivariate analysis to assess sociodemographic factors associated with HBV knowledge • Asian language ability, Asian ethnicity, practice site, type of clinician, years since graduation, number of clinical practice days/week Many (46%) unaware of treatment options CONCLUSIONS • Many clinicians attending a primary care CME conference have important knowledge gaps about chronic HBV infection. • Improving PCPs’ knowledge about HBV and at risk populations may improve detection of individuals who are chronically infected with HBV. • San Francisco Board of Supervisors resolution #659-06: goal of universal hepatitis B testing and vaccination for all Asian and Pacific Islander residents of San Francisco. One objective of the SF Hep B Free campaign includes educational opportunities for PCPs to address the deficiencies noted in this study. Acknowledgements: San Francisco Department of Public Health, Doug Bauer, Alka Kanaya, Bernard Lo, Michael Ngai, Kristen Reid