美国宾夕法尼亚大学Shivan J Mehta团队研究了改善丙型肝炎筛查人群健康推广的行为干预措施。2021年5月18日，《英国医学杂志》发表了该研究。
为了评估选择退出框架并结合行为科学概念的信息传递或电子通信，是否会增加1945-1965年间出生的丙型肝炎病毒（HCV）患者的筛查率，2019年4月至2020年5月，研究组在美国费城一家学术卫生系统的43个初级保健实践中进行了一项实用随机对照试验。
研究组招募1945-1965年间出生的患者，无筛查史，在登记期前两年内至少进行过两次初级保健就诊。这项多层次试验分为两个研究。子研究A包括1656名符合条件的患者，由17名初级保健临床医生进行随访。将其按1：1随机分组，分别接受一封关于HCV筛查的邮件（仅信件），或一封类似的带有HCV筛查检验申请的信件（信件+申请）。
子研究B包括剩下的19837名符合条件的患者，由417名临床医生进行随访。将活跃的门户网站用户患者按1：5随机分组，分别接受一封关于HCV筛查的邮件（仅信件），或一封内容相似的患者门户网站信息（患者门户网站）；不活跃的门户网站患者仅收到一封信。在析因设计中，子研究B的患者也被1：1随机分组，分别接受标准内容（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）。主要观察指标为4个月内完成HCV筛查的患者比例。
共有21303例患者纳入意向治疗分析。在子研究A的1642名患者中，信件组完成筛查的比例为19.2%，显著低于信件+申请组（43.1%）。在子研究B的19661名患者中，常规护理内容组完成筛查的比例为14.6%，而行为科学内容组为13.6%，组间差异不显著。在活跃的门户网站用户患者中，信件组完成筛查的比例为17.8%，显著高于门户网站消息组（13.8%）。
总之，通过包括一个签署检验申请以及外延内容来选择退出框架，可扩大HCV筛查率。行为科学信息内容并没有增加筛查接受率，邮寄信件比患者门户网站信息可获得更高的接受率。
附：英文原文
Title: Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial
Author: Shivan J Mehta, Susan C Day, Anne H Norris, Jessica Sung, Catherine Reitz, Colin Wollack, Christopher K Snider, Pamela A Shaw, David A Asch
Issue&Volume: 2021/05/18
Abstract:
Objective 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.
Design Pragmatic randomized controlled trial.
Setting 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020.
Participants 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.
Interventions 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 19837 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).
Main outcome measures Proportion of patients who completed HCV testing within four months.
Results 21303 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 19661 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).
Conclusions 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.
DOI: 10.1136/bmj.n1022
Source: https://www.bmj.com/content/373/bmj.n1022
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
