Primary care physicians miss hepatitis vaccine targets

Primary care physicians are failing to meet guidelines for hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination in patients with chronic hepatitis C (HCV) infection, according to US research.

The study also found that family medicine physicians were less knowledgeable about the need for vaccination than their internal medicine counterparts.

"The results of this study suggest that there are substantial gaps in the knowledge and a wide variability in the practice of [internal medicine] and [family medicine] physicians with regard to vaccination of HCV+ patients," say K Herzog (New York University, USA) and colleagues.

The authors received completed questionnaires regarding knowledge about vaccination in HCV+ patients from 557 family care physicians and 652 internal medicine physicians. They noted that internal medicine physicians were significantly more likely to report seeing three or more HCV+ patients per week than family medicine physicians (34.8 vs 29.3%).

Of the family medicine physicians who responded, 62.7% and 65.4% knew that HCV+ patients who test positive for antibodies should receive HAV and HBV vaccination, respectively, compared with 76.5% and 79.6% of internal medicine physicians.

In addition, only 56.4% and 55.7% of family medicine physicians knew that HCV and HIV-co-infected patients required HAV and HBV vaccination, respectively. This compared with 69.9% and 72.9% of internal medicine physicians.

When the physicians were asked about barriers to vaccination, they reported obstacles such as patient refusal, cost, and time constraints. However, Herzog and colleagues also note that some barriers mentioned, such as feeling uncomfortable with vaccination and lacking knowledge of its safety and efficacy, are susceptible to change through educational programs.

The authors explain in the International Journal of Clinical Practice that in the USA, uptake of the recommended vaccination of HCV+ patients has been poor but the role of primary care in this has been little explored. They say that interventions are needed to prevent the morbidity and mortality associated with HAV and HBV infection.

"Among other strategies, physician education and strong practice patterns are needed as well as a healthcare system with wide acknowledgement of the benefits of HAV and HBV vaccination in chronic HCV-infected patients," they conclude.

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