Physician nonadherence with a hepatitis C screening program

William N. Southern, Mari Lynn Drainoni, Bryce D. Smith, Elisa Koppelman, Melissa D. McKee, Cindy L. Christiansen, Allen L. Gifford, Cindy M. Weinbaum, Alain H. Litwin

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Testing for patients at risk for hepatitis C virus (HCV) infection is recommended, but it is unclear whether providers adhere to testing guidelines. We aimed to measure adherence to an HCV screening protocol during a multifaceted continuous intervention. Subjects and Methods: Prospective cohort design to examine the associations between patient-level, physician-level, and visit-level characteristics and adherence to an HCV screening protocol. Study participants included all patients with a visit to 1 of the 3 study clinics and the physicians who cared for them. Adherence to the HCV screening protocol and patient-level, physician-level, and visit-level predictors of adherence were measured. Results: A total of 8981 patients and 154 physicians were examined. Overall protocol adherence rate was 36.1%. In multivariate analysis, patient male sex (odds ratio [OR] = 1.18), new patient (OR = 1.23), morning visit (OR = 1.32), and patients'; preferred language being non-English (OR = 0.87) were significantly associated with screening adherence. There was a wide variation in overall adherence among physicians (range, 0%-92.4%). Screening adherence continuously declined from 59.1% in week 1 of the study to 13.7% in week 15 (final week). When implementing complex clinical practice guidelines, planners should address physician attitudinal barriers as well as gaps in knowledge to maximize adherence.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalQuality management in health care
Issue number1
StatePublished - 2014


  • Clinical practice patterns
  • community-based participatory research
  • guideline adherence
  • hepatitis C
  • intervention studies
  • mass screening

ASJC Scopus subject areas

  • Leadership and Management
  • Health(social science)
  • Health Policy
  • Care Planning


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