Research Article: A Comparison of Patient Satisfaction with Emergency Department Opt-In and Opt-Out Rapid HIV Screening

Date Published: February 16, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Douglas A. E. White, Alicia N. Scribner, Maria E. Martin, Stacy Tsai.


Study objective. To compare patient satisfaction with emergency department (ED) opt-in and opt-out HIV screening.
Methods. We conducted a survey in an urban ED that provided rapid HIV screening using opt-in (February 1, 2007–July 31, 2007) and opt-out (August 1, 2007–January 31, 2008) approaches. We surveyed a convenience sample of patients that completed screening in each phase. The primary outcome was patient satisfaction with HIV screening. Results. There were 207 and 188 completed surveys during the opt-in and opt-out phases, respectively. The majority of patients were satisfied with both opt-in screening (95%, 95% confidence interval [CI] = 92–98) and opt-out screening (94%, 95% CI = 89–97). Satisfaction ratings were similar between opt-in and opt-out phases even after adjusting for age, gender, race/ethnicity, and test result (adjusted odds ratio 1.3, 95% CI = 0.5–3.1).
Conclusions. Emergency department patient satisfaction with opt-in and opt-out HIV screening is similarly high.

Partial Text

The study flow is outlined in Figure 1. For the opt-in versus the opt-out screening phases, results were as follows: there were 23,236 potentially eligible patients versus 26,757; screening offer rate was 27.9% (6,479/23,236) versus 75.8% (20,280/26,757) (P < 0.001); screening acceptance rate was 62.7% (4,061/6,479) versus 30.9% (6,273/20,280) (P < 0.001); testing completion rate was 99.8% (4,053/4,061) versus 74.6% (4,679/6,273) (P < 0.001); overall screening rate was 17.4% (4,053/23,236) versus 17.5% (4,679/26,757) (P = 0.90). The CDC has called for “explicit and measurable indicators to measure the progress on the process and outcomes” of the revised recommendations [15]. Since release of the 2006 recommendations, three ED studies have reported on specific outcomes associated with opt-out screening, including the number of persons tested, the number of patients receiving HIV care as a result of screening, baseline CD4 count, and number of false-positive screening test results [14, 16, 17]. This is the first study to focus on patient satisfaction and patient attitudes about HIV screening, and to compare these outcomes between opt-in and opt-out screening programs. Patient satisfaction with ED-based HIV screening may be an important determinant of a program's success. Not only may patient satisfaction influence acceptance rates but it may also affect the willingness of administrators and legislators to support screening programs. Our results suggest that, among the subset of ED patients surveyed, satisfaction with HIV screening is high, regardless of whether opt-in or opt-out screening is implemented. Furthermore, patients did not feel coerced into testing and patient autonomy was preserved even with opt-out methods and elimination of separate written consent. These results may encourage more widespread implementation of opt-out HIV screening in EDs.   Source:


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