PDF(Pubmed)
Abstract：
BACKGROUND: Despite curative treatment options since 2014, only 12% of individuals in Washington State diagnosed with Hepatitis C (HCV) received treatment in 2018. Washington State agencies launched an elimination plan in 2019 to promote access to and delivery of HCV screening and treatment. The purpose of this study is to evaluate provider and health system barriers to successful implementation of HCV screening and treatment across Washington State.
METHODS: This is a cross-sectional online survey of 547 physicians, nurse practitioners, physician assistants, and clinical pharmacists who provide care to adult patients in Washington State conducted in 2022. Providers were eligible if they worked in a primary care, infectious disease, gastroenterology, or community health settings. Questions assessed HCV screening and treating practices, implementation barriers, provider knowledge, observed stigma, and willingness to co-manage HCV and substance use disorder. Chi-squared or fishers exact tests compared characteristics of those who did and did not screen or treat.
RESULTS: Provider adoption of screening for HCV was high across the state (96%), with minimal barriers identified. Fewer providers reported treating HCV themselves (28%); most (71%) referred their patients to another provider. Barriers identified by those not treating HCV included knowledge deficit (64%) and lack of organizational support (24%). The barrier most identified in those treating HCV was a lack of treating clinicians (18%). There were few (< 10%) reports of observed stigma in settings of HCV treatment. Most clinicians (95%) were willing to prescribe medication for substance use disorders to those that were using drugs including alcohol.
CONCLUSIONS: Despite widespread screening efforts, there remain barriers to implementing HCV treatment in Washington State. Lack of treating clinicians and clinician knowledge deficit were the most frequently identified barriers to treating HCV. To achieve elimination of HCV by 2030, there is a need to grow and educate the clinician workforce treating HCV.
METHODS: This is a cross-sectional online survey of 547 physicians, nurse practitioners, physician assistants, and clinical pharmacists who provide care to adult patients in Washington State conducted in 2022. Providers were eligible if they worked in a primary care, infectious disease, gastroenterology, or community health settings. Questions assessed HCV screening and treating practices, implementation barriers, provider knowledge, observed stigma, and willingness to co-manage HCV and substance use disorder. Chi-squared or fishers exact tests compared characteristics of those who did and did not screen or treat.
RESULTS: Provider adoption of screening for HCV was high across the state (96%), with minimal barriers identified. Fewer providers reported treating HCV themselves (28%); most (71%) referred their patients to another provider. Barriers identified by those not treating HCV included knowledge deficit (64%) and lack of organizational support (24%). The barrier most identified in those treating HCV was a lack of treating clinicians (18%). There were few (< 10%) reports of observed stigma in settings of HCV treatment. Most clinicians (95%) were willing to prescribe medication for substance use disorders to those that were using drugs including alcohol.
CONCLUSIONS: Despite widespread screening efforts, there remain barriers to implementing HCV treatment in Washington State. Lack of treating clinicians and clinician knowledge deficit were the most frequently identified barriers to treating HCV. To achieve elimination of HCV by 2030, there is a need to grow and educate the clinician workforce treating HCV.
摘要：
背景：尽管自2014年以来选择了治愈性治疗方案，但华盛顿州仅有12％的人诊断为丙型肝炎（HCV）在2018年接受了治疗。华盛顿州机构于2019年启动了一项消除计划，以促进获得和提供HCV筛查和治疗。这项研究的目的是评估提供者和卫生系统在华盛顿州成功实施HCV筛查和治疗的障碍。
方法：这是一项针对547名医生的横断面在线调查，执业护士,医师助理,和为华盛顿州成年患者提供护理的临床药师于2022年进行。如果提供者在初级保健部门工作，他们就有资格，传染病,胃肠病学,或社区健康环境。问题评估了HCV筛查和治疗实践，实施障碍，提供者知识，观察到的污名，并愿意共同管理HCV和物质使用障碍。卡方或渔民精确测试比较了那些进行和未进行筛查或治疗的人的特征。
结果：全州的HCV筛查提供者使用率很高（96％），确定最小的障碍。更少的提供者报告自己治疗HCV（28％）；大多数（71％）将患者转介给另一个提供者。未治疗HCV的患者发现的障碍包括知识不足（64％）和缺乏组织支持（24％）。在治疗HCV的患者中最明显的障碍是缺乏治疗临床医生（18％）。很少（<10％）报告在HCV治疗的设置中观察到的污名。大多数临床医生（95％）愿意为使用酒精等药物的患者开处方治疗药物使用障碍。
结论：尽管进行了广泛的筛查工作，在华盛顿州实施HCV治疗仍然存在障碍.缺乏治疗临床医生和临床医生知识缺陷是治疗HCV最常见的障碍。为了到2030年消除HCV,需要发展和教育治疗HCV的临床医生队伍。
方法：这是一项针对547名医生的横断面在线调查，执业护士,医师助理,和为华盛顿州成年患者提供护理的临床药师于2022年进行。如果提供者在初级保健部门工作，他们就有资格，传染病,胃肠病学,或社区健康环境。问题评估了HCV筛查和治疗实践，实施障碍，提供者知识，观察到的污名，并愿意共同管理HCV和物质使用障碍。卡方或渔民精确测试比较了那些进行和未进行筛查或治疗的人的特征。
结果：全州的HCV筛查提供者使用率很高（96％），确定最小的障碍。更少的提供者报告自己治疗HCV（28％）；大多数（71％）将患者转介给另一个提供者。未治疗HCV的患者发现的障碍包括知识不足（64％）和缺乏组织支持（24％）。在治疗HCV的患者中最明显的障碍是缺乏治疗临床医生（18％）。很少（<10％）报告在HCV治疗的设置中观察到的污名。大多数临床医生（95％）愿意为使用酒精等药物的患者开处方治疗药物使用障碍。
结论：尽管进行了广泛的筛查工作，在华盛顿州实施HCV治疗仍然存在障碍.缺乏治疗临床医生和临床医生知识缺陷是治疗HCV最常见的障碍。为了到2030年消除HCV,需要发展和教育治疗HCV的临床医生队伍。
