219772 Medical training does not adequately prepare physicians to manage chronic hepatitis B infection in the high-risk Asian and Pacific Islander patient population

Sunday, November 7, 2010

Bing Mei Wang , Asian Liver Center, Stanford University, Palo Alto, CA
Ellen Chang, ScD , Northern California Cancer Center, Fremont, CA
Samuel So, MD , Asian Liver Center, Stanford University, Palo Alto, CA
Stephanie Chao, MD , Asian Liver Center, Stanford University, Palo Alto, CA
  
BACKGROUND: Asian and Pacific Islander (API) Americans bear a disproportionate burden of chronic infection with the hepatitis B virus (HBV); while API comprise 4.3% of the general US population, they represent over 50% of those infected. Left untreated, chronic HBV infection results in a high mortality rate (25%) due to liver disease and cancer. OBJECTIVE: Studies indicate that physicians sub-optimally diagnose and manage patients with chronic HBV infection. We suspect that medical residency does not provide adequate HBV training, especially with respect to the high prevalence API population. METHODS: We recruited physicians from a tertiary care center and the greater San Francisco Bay Area. We divided them into four cohorts: incoming interns (n=67), outgoing interns (n=62), outgoing residents (n=27), and attending physicians (n=72). We administered a survey to assess knowledge of diagnosis, management, and long-term follow up procedures. RESULTS: Preliminary results reveal that knowledge is poor overall. Only 22.8% of physicians could identify the correct serologic test to screen for hepatitis B; 12.09% of physicians knew the high prevalence rate amongst API, and 34.6% knew how to screen infected individuals for liver cancer. We used Wald chi-square analysis to determine the effect of education level on knowledge; in all cases except for knowledge of liver cancer screening (p=0.0032), knowledge did not significantly increase with further medical training. CONCLUSION: Medical training currently does not adequately train providers about chronic hepatitis B screening and management; new approaches to physician education are necessary.

Learning Areas:
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related education

Learning Objectives:
1. Describe which populations are at highest risk for chronic hepatitis B infection and should undergo routine screening. 2. Discuss current deficits in physician knowledge with respect to chronic hepatitis B prevention and management. 3. Design a strategy for improving physician knowledge.

Keywords: Asian and Pacific Islander, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the research presented in the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2050.0: Asian & Pacific Islander Disparities in Infectious/Communicable Disease