CHRONIC HEPATITIS B GUIDELINE ADHERENCE

Asians have the highest prevalence of all ethnic groups as chronic carriers of hepatitis B but up to 50% of healthcare providers fail to properly manage the disease. This study summarized existing knowledge and comprehensively evaluated provider nonadherence to the chronic hepatitis B (CHB) guidelines in Asian Americans. A systematic literature review was conducted utilizing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) framework. A search was performed in PubMed, CINAHL (the Cumulative Index of Nursing and Allied Health Literature), and Cochrane databases from January 2006 to January 2016. Only primary studies that evaluated provider adherence to hepatitis B treatment guidelines were included. Foreign studies outside the United and non-English articles were excluded. Studies that did not evaluate nonadherence were also excluded. Only 14 studies were identified that met the inclusion criteria for this review. These studies consisted of 6 surveys of providers’ knowledge and/or attitudes, 6 retrospective chart reviews, and 2 mixed methods. All included studies evaluated provider adherence to CHB management with respect to four areas: (a) timely routine laboratory checks, (b) treatment initiation when indicated, (c) liver biopsy, and (d) hepatocellular carcinoma (HCC) screening. One investigator screened the titles and abstracts of each article. From the included studies, barriers were abstracted via a thematic analysis. A framework for guideline adherence was constructed based on the health belief model. iv A total of 35 barriers were categorized into 6 health-belief-model-based themes: (a) self-efficacy (lack of knowledge, unfamiliarity, or unawareness), (b) perceived barriers (patient culture, language, reluctance, or beliefs), (c) perceived severity (factors associated with routine labs and treatment), (d) perceived susceptibility (factors associated with HCC screening), (e) perceived benefits (confidence in the guidelines), and (f) modifying factors (demographics, attitudes, sociopsychological factors). This review highlights the primary barriers to provider adherence to guidelines and offers suggestions and a framework for further research. In this project, treatment disparity was evaluated from an atypical perspective, placing the burden of disease management on providers. The CHB adherence framework provides a foundation for future models on nonadherence from a behavioral and psychosocial standpoint. Providers can evaluate their current practices and improve their management of CHB with the use of this framework