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Table 2 Comparing and contrasting quantitative and qualitative results

From: There’s just not enough time: a mixed methods pilot study of hepatitis C virus screening among baby boomers in primary care

Construct

Quantitative Findings (n = 22)

Qualitative Findings (n = 9)

Screening practices

Recommendation awareness

 

“I mean, there’s so much to cover in every primary care doctor visit. …Sometimes there’s just not enough time to introduce the idea of hepatitis C screening and why we recommend it.”

“For [baby boomer] patients without risk factors, ideally, we’ll have a conversation about a one-time screening for hepatitis C. At least that’s our goal. I think sometimes, things get busy, time runs low, and that then maybe gets deprioritized.”

“We order [HCV screening] and we tell the patient, ‘You know you’re due for Hepatitis C screening because you were born between this year and this year, and you’re high-risk.’ If they’re agreeable to it, then we just order the lab and have it done.”

“Generally using the rule of thumb between people that were born between 1945 and 1965, if they had illicit drug use or injectable drug use, if they were giving any blood transfusions before about 1990. Obviously if they have acute elevations of liver enzymes, I’m definitely screening for all hepatitis during that point. If there’s a needle stick, then absolutely screen for all hepatitis at that point.”

No

3 (13.6)

Yes

19 (86.4)

Recommendation strength

 

Strongly recommends

16 (72.7)

Recommends, but not strongly

6 (27.3)

Makes no recommendation for or against

0 (0.0)

Recommends against

0 (0.0)

Personal screening practices

 

Rarely screens patients

0 (0.0)

Screens patients with behavioral risk factors (e.g. injection drug use)

15 (68.2)

Screens patients when clinically indicated (e.g. elevated ALT)

18 (81.8)

Screens patients with age-based risk factors (e.g. baby boomers)

22 (100.0)

Screening presentation

 

Screening is routine

22 (100.0)

Screening is optional

0 (0.0)

I do not discuss screening with baby boomer patients

0 (0.0)

Consistency of recommendation

 

Occasionally (10–39% of the time)

2 (9.1)

About half of the time (40–59% of the time)

2 (9.1)

Usually (60–90% of the time)

11 (50.0)

Always/almost always (greater than 90% of the time)

6 (27.3)

Knowledge (% correct)

You can get HCV from a blood transfusion from an infected donor (true)

22 (100.0)

“I know basics about hepatitis C but I’m not comfortable talking about prognosis or individual screening or staging. … I’m going to refer them to a gastroenterologist and have them take it from there.”

“It’s … not something that I’ve learned, not something I’m comfortable with, so I typically do just refer them to GI, and they take care of it.”

You can get HCV by having sex with someone infected with HCV (true)

20 (90.9)

Perinatal transmission is not possible (false)

18 (81.8)

HCV can be transmitted through contaminated needles (true)

22 (100.0)

HCV can be contracted through injection drug use (true)

22 (100.0)

People who report risk behaviors should be screened yearly for HCV (true)

21 (95.5)

The CDC and USPSTF recommend HCV screening for baby boomers only if they report a behavioral risk factor (false)

22 (100.0)

Available curative treatments for HCV have substantial side effects (false)

16 (72.7)

Approximately 1 in 30 baby boomers is currently infected with HCV (true)

10 (45.5)

Total score (mean[SD]; Range: 0–9)

7.86 (0.94)

Provider Self-Efficacy

How would you rate your proficiency in the following areas…(mean score from 0 [none] to 4 [expert])

 

“There are two of us that do the treatment. So, the other ones – they would refer them to us…for a couple visits during the Hep C treatment.”

“Generally what I’ll do is provide a referral to see a GI specialist. I might order additional testing that I would anticipate the GI doctor would want, and then checking for vaccination status of hepatitis A and B.

Ability to identify patients who should be screened

2.6 (0.67)

Ability to discuss HCV infection with patients

2.5 (0.60)

Ability to adequately refer patients to proper specialist for care

3.0 (0.72)

Ability to execute the proper next steps should a patients screen positive for HCV

2.8 (0.81)

Ability to treat HCV-infected patients and manage side-effects

1.1 (0.94)

Ability to provide a brief alcohol screen, counseling, and referral for alcohol use treatment services

2.4 (0.59)

Ability to assess and manage substance abuse comorbidities in HCV-infected patients

1.9 (0.71)

Ability to implement in-clinic procedures for universal screening of baby boomers

2.1 (0.89)

Total score (Range: 0–32)

18.4 (3.8)

Barriers

Please indicate the degree to which you agree or disagree with the following statements… (mean score from 1 [strongly disagree] to 5 [strongly agree])

 

“Hesitation if the test is covered by the insurance or not. That’s their biggest concern when they’re getting blood work is try to minimize cost and copays

“So, the provider barrier is always time. So, sometimes of just like, I’ve already dealt with mammogram and colonoscopy today. That’s enough screening stuff in one visit. I’ll do this one next time type thing.”

“I would say time is the single biggest barrier to it. Whether it’s there’s just not enough time within the office visit to have a conversation about it, or whether there’s 12 other things to address and it just escapes my mind.”

“But there’s so many things that could be addressed during, you know, an annual, like it could be that they maybe have come for their annual but you find that their A1C is like 11% and so you’re kind of stuck doing a different type of visit.”

“Well – there’s never enough time. Really ... there’s so many things that need to be screened. It really depends on the patient and their other issues.”

I do not have time to discuss HCV screening with my patients

2.0 (1.05)

I am not comfortable managing my patients if they screen positive for HCV infection

1.5 (0.68)

Screening for HCV infection is a less-urgent problem for my patients, compared to their other problems

2.7 (1.10)

My patients are not interested in screening when I recommend it for them

2.0 (0.67)

My patients do not have insurance to cover the cost of HCV screening

1.9 (0.77)

The cost for HCV treatment is a barrier for my patients

2.8 (1.30)

Total score (Range: 5–30)

12.9 (3.02)