Though hepatitis B virus infection is vaccine preventable, it remains a leading cause of serious liver disease including cirrhosis and hepatocellular carcinoma. With more than 2 million individuals living in the United States chronically infected, increasing the adult vaccination rate, currently estimated at only 26.3% based on large patient self-report surveys, is a public health imperative. Primary care visits represent an opportunity to assess hepatitis B risk and vaccination status, and to administer vaccine.
The purpose of the study was to determine the factors that affect primary care physician recommendation and delivery of hepatitis B vaccine as part of routine adult care, and measure vaccination rate in the primary care setting. A survey was developed, validated and completed online by a random sample of 319 physicians who provide routine primary care for >100 adult patients each month. Adult hepatitis B vaccination rate was calculated based on physician-reported caseload and number of vaccinations administered over a 6 month period. In addition to practice descriptors, 24 survey items assessed physician knowledge, attitudes and practices related to vaccination rate.
Statistical analyses were conducted using SPSS software. The median and mean vaccination rates were 3.3% and 9.4%, respectively. Vaccination rates were highest among physicians practicing medicine for <10 years, in private hospital settings located in urban areas. Vaccination significantly correlated (p<.05) with routine assessment of hepatitis B risk, guidelines-based vaccination, and distribution of patient education materials. Focusing on history of intravenous drug use as the key indication for vaccination and concerns regarding related liability were found to be barriers to vaccination. Forward multiple linear regression analysis generated a model that predicted 26% of variance in vaccination rate, which suggested that physicians who have integrated risk assessment, discussion of vaccination rationale with patients, and vaccine delivery into their routine primary care practices exhibit higher vaccination rates.
The results suggest that adult hepatitis B vaccination rates may be increased through physician education that reinforces identification of CHB risk factors other than intravenous drug use and clarifies the limited nature of vaccine injury liability, as well as health policies that incentivize vaccination in the primary care setting.
|Advisor:||Marks, Ray, Edelson, Paul J.|
|School:||Teachers College, Columbia University|
|Department:||Health and Behavior Studies|
|School Location:||United States -- New York|
|Source:||DAI-A 75/09(E), Dissertation Abstracts International|
|Subjects:||Public health, Health education, Virology, Health care management|
|Keywords:||Hepatitis b, Vaccination|
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