Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial
Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial
复制标题
DOI：
10.1136/bmj.h6895
复制
发表时间：
2016-01-19
影响因子：
105.7
通讯作者：
Kaplan, Beth C.
中科院分区：
文献类型：
--
作者：
Montoy, Juan Carlos C.;Dow, William H.;Kaplan, Beth C.
研究问题：在急诊科接受治疗的患者中，默认检测（选择加入、选择退出和主动选择）对接受HIV检测的可能性有何影响？方法：这是一项随机临床试验，在城市教学医院和区域创伤中心的急诊科进行。年龄在13-64岁之间的患者被随机分配到选择加入，选择退出和主动选择HIV检测服务。主要结果是HIV检测接受率。Denver风险评分用于将患者分为低、中、高HIV感染风险。研究答案和局限性38.0%在选择性检测组中，有611/1607的患者接受了HIV检测，主动选择组（815/1628）（差异13.3%，95%置信区间9.8%-16.7%）和选择退出组65.9%（1031/1565）（差异27.9%，24.4%-31.3%）。与主动选择测试相比，选择退出测试导致测试接受度增加了14.6（11.1至18.1）个百分点。在所有组中，被确定为中度和高度风险的患者比低风险患者更有可能接受检测（中度风险差异为6.4%（3.4%至9.3%），高度风险差异为8.3%（3.3%至13.4%））。选择退出效应在那些报告高风险行为的人中显着较小，但主动选择效应并没有因报告的风险行为水平而显着变化。患者在接受HIV检测后同意纳入研究，并且纳入因治疗分配而略有不同。这项研究在一个城市的一个县医院进行，这个城市在HIV检测方面有些独特;尽管检测接受率本身可能会有所不同，但选择加入与主动选择与选择退出检测方案的不同模式并不存在。本文补充主动选择是一种独特的检测方案，其检测接受模式可能最接近患者的真实偏好。与主动选择检测相比，选择退出方案可以大幅增加艾滋病毒检测，而选择加入方案可能会减少检测。
STUDY QUESTIONWhat is the effect of default test offers-opt-in, opt-out, and active choice-on the likelihood of acceptance of an HIV test among patients receiving care in an emergency department?METHODSThis was a randomized clinical trial conducted in the emergency department of an urban teaching hospital and regional trauma center. Patients aged 13-64 years were randomized to opt-in, opt-out, and active choice HIV test offers. The primary outcome was HIV test acceptance percentage. The Denver Risk Score was used to categorize patients as being at low, intermediate, or high risk of HIV infection.STUDY ANSWER AND LIMITATIONS38.0% (611/1607) of patients in the opt-in testing group accepted an HIV test, compared with 51.3% (815/1628) in the active choice arm (difference 13.3%, 95% confidence interval 9.8% to 16.7%) and 65.9% (1031/1565) in the opt-out arm (difference 27.9%, 24.4% to 31.3%). Compared with active choice testing, opt-out testing led to a 14.6 (11.1 to 18.1) percentage point increase in test acceptance. Patients identified as being at intermediate and high risk were more likely to accept testing than were those at low risk in all arms (difference 6.4% (3.4% to 9.3%) for intermediate and 8.3% (3.3% to 13.4%) for high risk). The opt-out effect was significantly smaller among those reporting high risk behaviors, but the active choice effect did not significantly vary by level of reported risk behavior. Patients consented to inclusion in the study after being offered an HIV test, and inclusion varied slightly by treatment assignment. The study took place at a single county hospital in a city that is somewhat unique with respect to HIV testing; although the test acceptance percentages themselves might vary, a different pattern for opt-in versus active choice versus opt-out test schemes would not be expected.WHAT THIS PAPER ADDSActive choice is a distinct test regimen, with test acceptance patterns that may best approximate patients' true preferences. Opt-out regimens can substantially increase HIV testing, and opt-in schemes may reduce testing, compared with active choice testing.