Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA.
BMJ. 2021 May 18;373:n1022. doi: 10.1136/bmj.n1022.
To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965.
Pragmatic randomized controlled trial.
43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020.
Patients born between 1945 and 1965 with no history of screening and at least two primary care visits in the two years before the enrollment period.
This multilevel trial was divided into two studies. Substudy A included 1656 eligible patients of 17 primary care clinicians who were randomized in a 1:1 ratio to a mailed letter about HCV screening (letter only), or a similar letter with a laboratory order for HCV screening (letter+order). Substudy B included the remaining 19 837 eligible patients followed by 417 clinicians. Active electronic patient portal users were randomized 1:5 to receive a mailed letter about HCV screening (letter), or an electronic patient portal message with similar content (patient portal); inactive patient portal users were mailed a letter. In a factorial design, patients in substudy B were also randomized 1:1 to receive standard content (usual care), or content based on principles of social norming, anticipated regret, reciprocity, and commitment (behavioral content).
Proportion of patients who completed HCV testing within four months.
21 303 patients were included in the intention-to-treat analysis. Among the 1642 patients in substudy A, 19.2% (95% confidence interval 16.5% to 21.9%) completed screening in the letter only arm and 43.1% (39.7% to 46.4%) in the letter+order arm (P<0.001). Among the 19 661 patients in substudy B, 14.6% (13.9% to 15.3%) completed screening with usual care content and 13.6% (13.0% to 14.3%) with behavioral science content (P=0.06). Among active patient portal users, 17.8% (16.0% to 19.5%) completed screening after receiving a letter and 13.8% (13.1% to 14.5%) after receiving a patient portal message (P<0.001).
Opt out framing and effort reduction by including a signed laboratory order with outreach increased screening for HCV. Behavioral science messaging content did not increase uptake, and mailed letters achieved a greater response rate than patient portal messages.
ClinicalTrials.gov NCT03712553.
评估选择退出框架、纳入行为科学概念的信息传递，或电子通信是否能提高 1945 年至 1965 年间出生的患者接受丙型肝炎病毒（HCV）筛查的比例。
实用随机对照试验。
2019 年 4 月至 2020 年 5 月期间，来自一个学术医疗系统（美国宾夕法尼亚州费城）的 43 个基层医疗机构。
无 HCV 筛查史且在入组前两年内至少有两次基层医疗就诊记录的 1945 年至 1965 年间出生的患者。
该多水平试验分为两项研究。子研究 A 纳入了 1656 名符合条件的患者，他们的 17 名基层医疗医生以 1:1 的比例被随机分配到接受 HCV 筛查的邮寄信件（仅信件）或包含 HCV 筛查实验室订单的类似信件（信件+订单）。子研究 B 纳入了其余的 19837 名符合条件的患者和 417 名临床医生。主动使用电子患者门户的患者以 1:5 的比例被随机分配到接受 HCV 筛查的邮寄信件（信件）或具有类似内容的电子患者门户消息（患者门户）；不活跃的患者门户用户收到了邮寄信件。在析因设计中，子研究 B 的患者还被随机分配 1:1 接受标准内容（常规护理）或基于社会规范、预期后悔、互惠和承诺原则的内容（行为内容）。
在四个月内完成 HCV 检测的患者比例。
21303 名患者被纳入意向治疗分析。在子研究 A 的 1642 名患者中，仅信件组有 19.2%（95%置信区间 16.5%至 21.9%）完成了筛查，而信件+订单组有 43.1%（39.7%至 46.4%）（P<0.001）。在子研究 B 的 19661 名患者中，有 14.6%（13.9%至 15.3%）在接受常规护理内容后完成了筛查，13.6%（13.0%至 14.3%）在接受行为科学内容后完成了筛查（P=0.06）。在活跃的患者门户用户中，17.8%（16.0%至 19.5%）在收到信件后完成了筛查，13.8%（13.1%至 14.5%）在收到患者门户消息后完成了筛查（P<0.001）。
选择退出框架和通过包括签名的实验室订单进行外展努力减少了 HCV 筛查的阻力。行为科学信息传递内容并未增加参与度，而邮寄信件的响应率高于患者门户消息。
ClinicalTrials.gov NCT03712553。
