1. A qualitative assessment of factors impacting adoption and implementation of USPSTF age-based hepatitis C virus screening recommendations
Amy B. Jessop, PhD, MPH, Janna Manjelievskaia, PhD (c), MPH, Tamar Klaiman, PhD, MPH, Department of Health Policy and Public Health, University of the Sciences,
Introduction
Methods
Results
Results
Smart tools:
All subjects stated the need for smart tools that would prompt appropriate actions at the point of care
Some resident physicians reported using a cell phone app from major advisory bodies, such as the USPSTF and CDC to perform recommended guidelines
Resident physicians reported a need for a more comprehensive electronic medical record system in which the most current guidelines and recommendations would be incorporated
Staying Up to Date on Guidelines:
Most residents looked to their attending physician for current screening practices
Most participants named as the least effective method of notification of new guidelines
Hepatitis C (HCV) virus affects an estimated 3-4 million Americans
HCV can lead to cirrhosis, liver cancer and liver transplant
An estimated 65% of Americans with HCV are unaware of their infection
Adults born between 1945 and 1965, the “baby boomers”, comprise 75% U.S. residents living with HCV
 In 2013, to improve identification of HCV-infected Americans USPSTF expanded its risk-based HCV screening recommendation to include
one-time screening for all baby boomers
Setting: A large family medicine clinic and residency program in suburban Philadelphia
Interviews were conducted with all staff who see adult patients at the practice (5 attending, 12 resident physicians and 1 nurse practitioner)
Knowledge:
Awareness of the expanded HCV recommendation varied by position with the NP and attending physicians most aware
Knowledge of guideline details was limited
Attitudes toward Guidelines:
Guidelines were viewed as helpful tools by all subjects, but the source of the guideline was considered before adoption
American Academy of Family Physicians (AAFP) was most often named as the preferred source of clinical practice guidelines
USPSTF was considered a credible source
Screening Practices:
Subjects who cared for HCV-affected patients reported a greater need and importance of HCV screening in their practice
Self-reported HCV screening rates ranged from 2-25%
Barriers to Screening:
Barriers included cost, the large number of recommended preventive actions (breast, cervical, colorectal cancer screenings and vaccinations), forgetting, patient push back and lack of time
Data Collection: In-person, semi-structured interviews were conducted and recorded. Subjects were asked about:
Knowledge, attitudes, and beliefs of clinical practice guidelines, in general
Awareness of USPSTF HCV recommendation
The need for this type of screening at their practice
Experience with and barriers to ordering HCV tests
Self-reported HCV screening rates among baby boomers
Their preferred methods of staying up to date on new guidelines.
Analysis: Researchers compiled responses to knowledge and sources of guidelines. Identified common themes for attitude, belief, and preferred methods for staying up to date
Conclusion
While knowledge of the “baby boomer” HCV screening recommendation varied among providers, adoption was low, with the NP reporting the highest screening rate at 25%
Smart tools at the point of care may improve screening rates in family practice settings
Born between 1945 and 1965? The USPSTF recommends you get tested for Hepatitis C virus
Acknowledgments
This study examines awareness and adoption of the “Baby Boomer” HCV screening recommendation
The authors would like to thank Drs. Kathleen Lawlor and Allen Dimino of Bryn Mawr Family Practice for their help in this project.