Original Article

Educational Intervention in Primary Care Residents’ Knowledge and Performance of Hepatitis B Vaccination in Patients with Diabetes Mellitus

Authors: Saowanee Ngamruengphong, MD, Jennifer L. Horsley-Silva, MD, Stephanie L. Hines, MD, Surakit Pungpapong, MD, Tushar C. Patel, MB, ChB, Andrew P. Keaveny, MD


Objectives: Although guidelines recommend hepatitis B virus (HBV) immunization for adults with diabetes mellitus (DM), vaccination rates remain low. Our aim was to evaluate knowledge and practice regarding HBV and to assess the effectiveness of a multifaceted educational program.

Methods: Primary care residents (n = 244) at three academic institutions were surveyed about various aspects of HBV. Residents at one training program were then randomly assigned to an educational intervention (E) (n = 20) and control group (C) (n = 19). The E group received a focused didactic lecture and periodic e-mail reminders with immediate feedback. We compared knowledge scores before and after the intervention. Chart audits were conducted to evaluate the residents’ behavior.

Results: A total of 103 (42%) residents responded to the survey. The survey indicated that residents lacked the necessary knowledge and risk assessment skills concerning HBV in patients with DM. In the controlled trial of the E intervention, both groups had similar baseline knowledge scores. The E group had a significant increase in the immediate postintervention knowledge scores from a mean of 29% at baseline to 70% ( P < 0.001) that was sustained 6 months postintervention (65%; P < 0.001). In the C group, 6-month postintervention scores were not different from baseline (38% vs 29%). No significant differences were observed in documentation skills.

Conclusions: A combined educational program was effective in enhancing knowledge about HBV and vaccination in DM but had limited influence on physicians’ practice. Further study incorporating system changes along with educational initiatives is required to improve clinical practice.

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