Riskbased HIV testing has been shown to miss a substantial number of patients infected with HIV. The Centers for Disease Control and Prevention (CDC) released recommendations in 2006 that patients between the ages of 13 and 64 should be offered HIV screening in all health care settings using an optout strategy. Clinician experiences with HIV optout screening in the inpatient setting have not been widely studied.
During the period of October 2008 through September 2009 a physiciandriven HIV optout testing program was in place at our 300 bed urban academic medical center. A forced screen function in the electronic admission order set required physicians to indicate whether consent for testing was obtained and to choose whether or not to order HIV testing. Following the one year program, a survey of admitting housestaff physicians was conducted via a webbased survey tool. Questions covered the following issues: opinions regarding HIV screening, knowledge of the optout screening program, education received regarding the program, use of the screening order set, and the consent process.
Surveys were sent to 267 housestaff physicians. 150 physicians completed the survey. More than half of physicians (63%) agreed that patients aged 1864 years old should be screened for HIV regardless of known risk factors, and even more (71%) agreed that hospitalization was a good time to screen patients. Physicians felt that they would have benefited from more education in one of the following areas: CDC guidelines for HIV screening (60%), the logistics of the HIV screening program (51%), the logistics of the HIV optout order set (46%), and followup available to patients (60%). Regarding obtaining verbal consent from patient for optout testing at the time of hospital admission, a majority of physicians reported only remembering to do so sometimes or rarely (54%), and 9% reported never remembering to obtain consent. 44% of physicians felt that they did not have adequate time to consent patients. Most physicians did not believe that the admitting physician should be responsible for HIV screening. When asked who would be bestsuited to consent patients, 35% favored a floor nurse, 11% an admission clerk, 30% a physician, and 23% a physician extender.
The majority of physicians agreed with screening patients for HIV and that hospitalization is an appropriate time to do this. However, this did not correlate with actual screening practices. Physicians often did not remember to obtain consent for testing, and many identified timeconstraints as a common barrier to screening. The majority of physicians did not agree that screening should be their responsibility. Further study is necessary to establish optimal characteristics of a successful inpatient HIV optout screening program.
To cite this abstract:Quartarolo J, Barger K. Physicians’ Perspectives on an Inpatient Optout Hiv Screening Program. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97630. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/physicians-perspectives-on-an-inpatient-optout-hiv-screening-program/. Accessed March 28, 2020.