Opt-Out Increases Hepatitis C Screening Uptake

WEDNESDAY, May 19, 2021 (HealthDay News) — Twice as many eligible patients get screened for hepatitis C virus (HCV) if it is already ordered for them at the time of a reminder, according to a study published online May 18 in The BMJ.

Shivan J. Mehta, M.D., from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues randomly assigned (1:1) 1,656 eligible patients of 17 primary care clinicians to either a mailed letter about HCV screening (letter only) or a similar letter with a laboratory order for HCV screening (letter+order). In substudy B, the authors randomly assigned 19,837 eligible patients (1:5) followed by 417 clinicians to receive either a mailed letter about HCV screening (letter) or an electronic patient portal message with similar content (patient portal); patients in substudy B were also randomly assigned in a 1:1 ratio to receive either standard content (usual care) or content based on principles of social norming, anticipated regret, reciprocity, and commitment (behavioral content).

The researchers found that in substudy A, 19.2 percent completed screening in the letter-only arm and 43.1 percent completed screening in the letter+order arm. In substudy B, 14.6 percent of patients completed screening with usual care content and 13.6 percent with behavioral science content. Also in substudy B, 17.8 percent of active patient portal users completed screening after receiving a letter and 13.8 percent after receiving a patient portal message.

“We think that sending the lab order with outreach was so successful because it framed screening as the default,” Mehta said in a statement. “This strategy was also successful because it reduced effort and the number of steps to screen by both the patient and clinician.”

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