Schechter-Perkins Elissa M, Koppelman Elisa, Mitchell Patricia M, Morgan Jake R, Kutzen Randie, Drainoni Mari-Lynn
Department of Emergency Medicine, Boston University School of Medicine.
Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research, ENRM Veterans Hospital.
Am J Emerg Med. 2014 Sep;32(9):1109-12. doi: 10.1016/j.ajem.2014.05.034. Epub 2014 Jun 2.
Understanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing.
This was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12. Patient demographic characteristics, health characteristics, and ED visit characteristics were compared to assess differences between those who accept and those who decline testing.
Of 4510 ED patients offered an HIV test, 3470 accepted for an acceptance rate of 77%. The most common reasons for declining were "no perceived risk" and "tested in the last 3 months." Those who accepted testing were more likely to be unmarried, less than age 35, Hispanic or African American, Spanish speaking, foreign born, have no primary care provider, report no pain at triage, have a daytime ED visit, and be discharged from the ED compared to admitted. Sex, employment status, and ED length of stay did not affect whether patients accepted testing.
Acceptance of ED-based rapid HIV testing is not universal, and there are both patient and visit characteristics consistently associated with declining testing. This detracts from the goal of using the ED to screen a large number of at-risk patients who do not have access to testing elsewhere.
了解接受和拒绝艾滋病毒检测的患者之间的差异，对于开发降低未确诊艾滋病毒风险患者中拒绝检测率的方法至关重要。本研究的目的是确定接受率和拒绝原因，并确定接受和拒绝检测的患者在患者特征或就诊特征方面是否存在差异。
这是一项对2011年11月1日至2012年10月31日期间在急诊科接受艾滋病毒检测的所有患者的回顾性病历审查。比较患者的人口统计学特征、健康特征和急诊科就诊特征，以评估接受检测和拒绝检测的患者之间的差异。
在4510名接受艾滋病毒检测的急诊科患者中，3470人接受了检测，接受率为77%。拒绝检测的最常见原因是“未意识到风险”和“在过去3个月内已检测过”。与拒绝检测的患者相比，接受检测的患者更可能未婚、年龄小于35岁、为西班牙裔或非裔美国人、说西班牙语、出生在国外、没有初级保健提供者、在分诊时报告无疼痛、在白天就诊于急诊科且从急诊科出院而非住院。性别、就业状况和急诊科住院时间并未影响患者是否接受检测。
基于急诊科的快速艾滋病毒检测的接受率并不普遍，并且存在一些与拒绝检测始终相关的患者特征和就诊特征。这不利于利用急诊科筛查大量无法在其他地方获得检测的高危患者这一目标。
