Hepatitis C virus knowledge improves hepatitis C virus screening practices among primary care physicians

Table 1 Information about the entire population invited to complete the survey (n = 163)

Variable	Total	Level	n	Percent
Completed survey	163	No	72	44.2
		Yes	91	55.8
Gender	163	Female	80	49.1
		Male	83	50.9
Primary practice location	163	Buffalo general medical center	33	20.3
		Erie county medical center	56	34.4
		Others	74	45.4
Role in primary care clinic	163	Resident in training	134	82.2
		Supervising physician/attending	29	17.8
Level of training1	143	Resident PGY1	48	33.6
		Resident PGY2	44	30.8
		Resident PGY3	40	28.0
		Resident PGY4 and above	11	7.7

¹Twenty subjects had missing values the variable “level of training”. PGY: Post-graduate year.

Table 2 Baseline characteristics of those individuals who responded to the survey (n = 91) from among the entire population invited to complete the survey (n = 163)

Variable	Total1	Level	Count/Mean	Percent/SD
Gender	91	Male	50	55.0
		Female	41	45.1
Specialty of practice	91	Family medicine	9	9.9
		Others	82	90.1
Primary practice location	91	Erie county medical center	36	39.6
		Buffalo general medical center	29	31.9
		Others	26	28.6
Evaluated at least one HCV patient in past 2 yr	90	Yes	47	52.2
		No	31	34.4
		Not Sure	12	13.3
Role in primary care clinic	91	Supervising physician/attending	15	16.5
		Resident in training	76	83.5
Level of training	85	Resident PGY1	25	29.4
		Resident PGY2	30	35.3
		Resident PGY3 or above	30	35.3
Awareness of age-based rule for screening	85	Yes	49	57.6
		No	36	42.4
Implementation of age-based rule for screening	85	Yes	34	40.0
		No	51	60.0
Knowledge of HCV natural history	85	Scores from 0 to 18	10.6	4.7
Knowledge of HCV treatment	82	Scores from 0 to 19	11.0	2.9

¹Missing values account for difference between number of responses recorded and the total number of survey respondents (n = 91). HCV: Hepatitis C virus; PGY: Post-graduate year.

Table 3 Regression analysis for Box-Cox transformed knowledge of hepatitis C virus natural history

Variable	Level	Estimation	SD	P value
Intercept		-24.90	1.39	0.001
Knowledge of HCV treatment		5.93	0.10	0.001
Gender	Male	Reference level
	Female	0.04	0.54	0.94
Primary practice location	Erie county medical center	Reference level
	Buffalo general medical center	0.54	0.77	0.49
	Others	-0.58	0.61	0.35
At least one HCV patient in past 2 yr	Yes	Reference level
	No/not Sure	-0.54	0.65	0.41
Level of training	Resident PGY 1	Reference level
	Resident PGY 2	-0.98	0.83	0.24
	Resident PGY 3 and above	0.06	0.78	0.94
Awareness of age-based rule for screening	Yes	Reference level
	No	-0.92	0.65	0.17
Implementation of age-based rule for screening	Yes	Reference level
	No	-0.07	0.65	0.91

The table illustrates those factors significantly associated with knowledge of HCV natural history. HCV: Hepatitis C virus; PGY: Post-graduate year.

Table 4 Regression analysis for Box-Cox transformed knowledge of hepatitis C virus treatment

Variable	Level	Estimation	SD	P value
Intercept		11.98	2.12	0.001
Knowledge of HCV natural history	score < 6	Reference level
	6 ≤ score < 15	-0.68	1.38	0.62
	15 ≤ score	-2.42	1.64	0.14
Gender	Male	Reference level
	Female	0.31	0.86	0.72
Primary practice location	Erie county medical center	Reference level
	Buffalo general medical center	0.27	1.20	0.82
	Others	-1.44	0.95	0.13
At least one HCV patient in past 2 yr	Yes	Reference level
	No/not sure	0.88	1.02	0.39
Level of training	Resident PGY 1	Reference level
	Resident PGY 2	1.51	1.30	0.25
	Resident PGY 3 and above	1.76	1.25	0.16
Awareness of age-based rule for screening	Yes	Reference level
	No	-2.21	1.00	0.03
Implementation of age-based rule for screening	Yes	Reference level
	No	1.01	1.01	0.32

The table illustrates those factors significantly associated with knowledge of HCV treatment. HCV: Hepatitis C virus; PGY: Post-graduate year.

Table 5 Regression analysis for implementation of birth cohort screening recommendations

Variable	Level	Estimate	SD	P value
Intercept		-4.48	2.19	0.04
Knowledge of HCV treatment		-0.02	0.11	0.86
Knowledge of HCV natural history		0.27	0.08	0.002
Gender	Male	Reference level
	Female	-0.94	0.68	0.17
Primary practice location	Erie county medical center	Reference level
	Buffalo general medical center	0.77	0.81	0.34
	Others	-0.36	0.72	0.62
At least one HCV patient in past 2 yr	Yes	Reference level
	No/not sure	2.43	0.90	0.001
Level of training	Resident PGY1	Reference level
	Resident PGY2	1.57	1.18	0.19
	Resident PGY3 or above	1.62	1.15	0.16
Awareness of age-based rule for screening	Yes	Reference level
	No	-2.32	0.88	0.01

The table illustrates those factors significantly associated with implementation of birth cohort screening recommendations. HCV: Hepatitis C virus; PGY: Post-graduate year.

Table 6 Primary care physician screening practices for hepatitis C virus infection

Question	Total	Option	Count	Percent
In the past 2 yr, have you ordered a test with an intention to screen for HCV?	85	Yes	75	88.2
		No or Not Sure	10	11.8
What is the strongest indication to screen for HCV?	85	Risk factor identified on patient encounter	26	30.6
		Patients born between 1945-1965	17	20.0
		Abnormal liver enzymes	42	49.4
How have you screened for hepatitis C?	85	HCV antibody	47	55.3
		Anti HCV antibody and HCV RNA PCR	11	12.9
		Other combinations of Anti HCV antibody, HCV RNA, liver function tests, and "let the lab choose"	27	31.8
Do you follow professional society guidelines for HCV screening?	85	Yes	61	71.8
		No	24	28.2

HCV: Hepatitis C virus.

Table 7 Primary care physician practice patterns for hepatitis C virus screening

Question	Total	Option	Count	Percent
How often are HCV risk factors assessed during a clinic visit?	85	Always	14	16.5
		Often	30	35.3
		Sometimes	25	29.4
		Rarely or never	16	18.8
Do you order an HCV screening test after identifying at least one risk factor?	85	Always	28	32.9
		Often	30	35.3
		Sometimes or rarely	27	31.8
Do you document HCV screening discussion/risk factor assessment in the health maintenance section of the patient’s chart?	85	Always or often	20	23.5
		Sometimes	24	28.2
		Rarely	29	34.1
		Never	12	14.1

HCV: Hepatitis C virus.

Table 8 Primary care physician perceptions toward screening for hepatitis C virus

Question	Total	Option	Count	Percent
Satisfied with the screening approach in the clinic	85	Yes	26	30.6
		No	25	29.4
		Not Sure	34	40.0
What is the most effective strategy in screening HCV in your clinic	85	Incorporate risk based screening	19	22.4
		Incorporate birth cohort based screening	11	12.9
		Incorporate both risk based and birth cohort screening	55	64.7
Most effect way to initiate screening during a clinic visit	85	Have patient fill out a screening questionnaire during wait period	47	55.3
		Incorporate mandatory screening questions into EMR	19	22.4
		Facilitate screening by use of posters in patient rooms	9	10.6
		Printed patient handout about screening	10	11.7

HCV: Hepatitis C virus; EMR: Electronic medical record.

Table 9 Primary care physician identified barriers to screening for hepatitis C virus (n = 85)

Option	Count	Percent
Inconsistency in offering HCV screening as a part of pre-set health maintenance protocol, time constraints in obtaining all HCV risk factors, unawareness of screening guidelines	14	16.5
Time constraints in obtaining all HCV risk factors	12	14.1
Unawareness of screening guidelines	12	14.1
Other combinations of inconsistency in offering HCV screening as a part of pre-set health maintenance protocol, time constraints in obtaining all HCV risk factors, taboo in asking confidential and personal information as outlined in the screening questionnaire, and unawareness of screening guidelines	47	55.3

HCV: Hepatitis C virus.