Uninsured and Medicaid-insured emergency department patients are more likely to agree to free rapid HIV testing
When all patients coming to a large, urban emergency department were offered free rapid human immunodeficiency virus (HIV) screening as part of the registration process, 75 percent opted out, found a new study. The policy that HIV screening be routine (not targeted to a specific population), with consent automatic unless the patient opts out, follows recommendations on screening in health care settings issued in 2006 by the Centers for Disease Control and Prevention. The goal was to improve the epidemiology of infection in the United States, where there are an estimated 230,000 HIV-infected persons who are unaware of their status and who inadvertently cause many of the 56,300 new HIV infections that occur each year.
The researchers analyzed patient demographics and insurance status from a prospective clinical trial at Denver Health from 2007 to 2009 to determine what factors made it most likely for the patient to accept free screening. They found that, compared with patients who had commercial insurance, self-pay (uninsured) and State-sponsored patients were 63 percent and 64 percent, respectively, less likely to opt-out of screening. Medicaid patients were 24 percent more likely to accept the screening than commercially insured patients. Race and ethnicity also appeared to influence opting-out: blacks were 29 percent less likely to opt out of screening than whites, and Hispanics were 17 percent more likely than whites to accept screening. The study was funded in part by the Agency for Healthcare Research and Quality (HS17526).
More details are in "Payer status, race/ethnicity, and acceptance of free routine opt-out rapid HIV screening among emergency department patients," by Jeffrey Sankoff, M.D., Emily Hopkins, M.S.P.H., Comilla Sasson, M.D., M.S., and others in the May 2012 American Journal of Public Health 102(5), pp. 877-883.
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