Outreach modality linked to HCV screening rates

More patients underwent hepatitis C virus screening when there was a reduced effort in attaining a laboratory order compared with patients who had to request screening on their own, according to research published in BMJ.

“Screening rates in this group remain low and variable across practices. ... Screening might be increased by complementing efforts in clinic with direct outreach to patients’ homes, which has been incorporated into other population health initiatives,” Shivan Mehta, MD, associate chief innovation officer at Penn Medicine, and colleagues wrote. “The conventional opt-in approach implies that the default is for the patient to not participate, while opt-out framing suggests that the status quo is for the patients to participate in the health promoting activity. Messaging that incorporates social norms, anticipated regret, reciprocity and commitment has increased energy conservation, cancer screening, workplace performance and vaccination rates.”

In a pragmatic, randomized-controlled trial, researchers evaluated 21,303 patients born between 1945 and 1965 (mean age, 63 years) with no history of HCV screening and divided patients into two substudies to investigate the success of opt-in vs. opt-out messaging regarding HCV screening. In substudy A, patients (n = 1,656) underwent 1:1 randomization and received either a mailed letter about HCV screening or a similar letter in addition to a signed laboratory order for screening. For substudy B, investigators randomly assigned patients 1:5 to receive either a mailed letter or an electronic patient portal message. Inactive portal users also received a mailed letter. Researchers further analyzed patients in substudy B for response to usual care content vs. response to behavioral content. The primary endpoint was HCV screening within 4-months.

According to substudy A data, 19.2% (95% CI, 16.5-21.9) of patients underwent HCV screening after they received a letter while 43.1% (95% CI, 39.7-46.4) of patients underwent screening after they received a letter in addition to a laboratory order. Among active patient portal users in substudy B, 17.8% (95% CI, 16-19.5) completed screening after they received a letter vs. 13.8% (95% CI, 13.1-14.5) after they received a patient portal message. Further substudy B analysis showed 14.6% (95% CI, 13.9-15.3) of patients responded to usual care content and 13.6% (95% CI, 13-14.3) of patients responded to behavioral content.

“Sending the lab slip with outreach had the greatest incremental effect on screening participation as it framed screening as the default (opt-out) and reduced effort by patients and clinicians,” Mehta told Healio. “There are many opportunities for health systems to embed randomization in routine operational projects to find out what works best.”