丙型肝炎患者参与的障碍和促进因素：对英国全科医生冠军的访谈研究
Barriers and facilitators to hepatitis C patient engagement: Interview study with general practitioner champions in England.
摘要(中文译文)
有些已被诊断为慢性丙型肝炎的患者失访，还有些患者可能尚未被诊断。全科医生（GP）可以通过提供检测、转诊至二级医疗以及协助处方，帮助这些患者获得照护。我们对14名全科医生进行了半结构化访谈，其中大多数人作为丙型肝炎全科医生倡导者（GP Champions），在英格兰国民医疗服务体系（NHS England）病毒性肝炎项目的资助下，与当地运营交付网络（ODNs）合作。我们采用主题分析，结合多层面模型（系统层面、提供者层面）和COM-B（能力、机会、动机：行为）框架，识别患者识别和（重新）参与照护的障碍与促进因素。系统层面的障碍包括全科医生缺乏丙型肝炎相关激励措施、初级医疗面临的压力、检索患者记录的困难，以及认为需要更好的流程来重新吸引失访患者。全科医生倡导者表示在协调区域患者（重新）参与策略方面存在挑战，但也报告了与运营交付网络、其他服务以及外展/社区合作伙伴的成功合作。所有全科医生在提供者层面的障碍包括缺乏丙型肝炎知识以及难以管理患者对话（能力）；全科医生人力不足以及难以联系患者（机会）。提供者层面的促进因素包括初级医疗具有整体性和患者可及性（机会），全科医生倡导者还报告了其角色如何赋予工作量能力以及其他全科医生/医疗专业人员的支持（机会），并增强了他们的个人成就感（动机）。访谈者对共享照护的反思以及对丙型肝炎照护未来的建议也有所呈现。本研究表明，聘用全科医生倡导者来发现患者并提供检测有诸多益处，但系统层面的障碍明显持续存在。受访者表示仍需要以整体方式对待患者，并建议通过服务/部门之间的共同努力来克服系统和提供者层面的障碍。
Abstract
There are people living with a previously diagnosed chronic hepatitis C infection who have been lost to follow up, and people who may have undiagnosed hepatitis C. General Practitioners (GPs) could help to support these patients into care, via offering testing, referring to secondary care, and facilitating prescribing. We conducted semi-structured interviews with 14 GPs, most of whom work with local Operational Delivery Networks (ODNs) with funding from the NHS England Viral Hepatitis Programme as hepatitis C GP Champions. A thematic analysis with a multi-level model (system, provider-levels) and the COM-B (capability, opportunity, motivation: behaviour) framework were used to identify barriers and facilitators to patient identification and (re)engagement. System-level barriers included a lack of hepatitis C incentives for GPs, pressures facing primary care, challenges searching patient records, and a perception that better processes are needed to re-engage patients lost to follow up. GP Champions expressed challenges coordinating regional patient (re)engagement strategies, but also reported successful collaborations with ODNs, other services, and outreach/community partners. Provider-level barriers for all GPs included lack of knowledge of hepatitis C and difficulty managing patient conversations (capability); and lack of GP capacity and difficulty contacting patients (opportunity). Provider-level facilitators included that primary care is holistic and accessible to patients (opportunity), and GP Champions reported how their roles have granted workload capacity and the support of other GPs/healthcare professionals (opportunity) and increased their feelings of personal reward (motivation). Interviewees' reflections on shared care and their suggestions for the future of hepatitis C care are also presented. This study demonstrates numerous benefits to employing GP Champions to find and offer testing to patients, however system-level barriers are notably persistent. Interviewees said there is further need to address patients holistically, and joint efforts between services/sectors were suggested as means to overcome system and provider level barriers.
如何引用
AMA
Avelie Stuart, Carina Hörst, Dolores Mullen, Catherine Lowndes, Ruth Simmons, Aneesha Noonan, et al. Barriers and facilitators to hepatitis C patient engagement: Interview study with general practitioner champions in England.. PloS one. 2026; doi:10.1371/journal.pone.0337867.
APA
Avelie Stuart, Carina Hörst, Dolores Mullen, Catherine Lowndes, Ruth Simmons, Aneesha Noonan, et al (2026). Barriers and facilitators to hepatitis C patient engagement: Interview study with general practitioner champions in England.. PloS one. https://doi.org/10.1371/journal.pone.0337867
GB/T 7714
Avelie Stuart, Carina Hörst, Dolores Mullen, Catherine Lowndes, Ruth Simmons, Aneesha Noonan, et al. Barriers and facilitators to hepatitis C patient engagement: Interview study with general practitioner champions in England.[J]. PloS one, 2026 doi:10.1371/journal.pone.0337867.
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