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 19 837 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 21 303 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 19 661 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. Trial registration ClinicalTrials.gov [NCT03712553][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03712553&atom=%2Fbmj%2F373%2Fbmj.n1022.atom

中文翻译：

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改善丙型肝炎筛查人群健康的行为干预措施：随机临床试验

目的评估选择退出框架，结合行为科学概念的消息传递或电子通信是否可以增加1945年至1965年之间出生的患者对丙型肝炎病毒（HCV）筛查的摄取。设计实用性随机对照试验。在2019年4月至2020年5月期间，从一个学术卫生系统（美国宾夕法尼亚州费城）设定43种初级保健实践。参与者1945年至1965年之间出生的患者，没有筛查史，并且在入学前两年内至少进行了两次初级保健就诊时期。干预措施这项多层次试验分为两项研究。研究A包括17656名初级保健临床医生的1656名合格患者，这些患者按1：1的比例随机分配到有关HCV筛查的邮寄信件中（仅字母），或类似的带有HCV筛查实验室指令的字母（字母+指令）。研究B包括其余19 837名合格患者，其次是417名临床医生。活跃的电子患者门户网站用户按1：5的比例随机分配，以接收有关HCV筛查的信件（信件）或内容相似的电子患者门户网站消息（患者门户网站）；不活跃的患者门户网站用户被邮寄了一封信。在析因设计中，子研究B的患者也按1：1的比例随机接受标准内容（通常护理）或基于社会规范，预期遗憾，互惠和承诺（行为内容）的内容。主要结果指标在四个月内完成HCV检测的患者比例。结果21 303例患者被纳入意向治疗分析。在研究A的1642名患者中，有19名患者。2％（95％的置信区间16.5％至21.9％）在仅字母的臂中完成了筛查，在字母+顺序的臂中完成了43.1％（39.7％至46.4％）（P <0.001）。在B子研究的19661名患者中，完成常规检查的筛查率为14.6％（13.9％至15.3％），而行为科学方面的筛查完成率为13.6％（13.0％至14.3％）（P = 0.06）。在活跃的患者门户网站用户中，有17.8％（16.0％至19.5％）收到信件后完成了筛查，在收到患者门户网站消息后达到了13.8％（13.1％至14.5％）（P <0.001）。结论通过包括签署的实验室订单以及扩大对HCV的筛查，可以选择取消框架和减少工作量。行为科学消息传递的内容并没有增加使用率，并且邮寄的信件比患者门户网站的消息具有更高的响应率。试用注册ClinicalTrials.gov [NCT03712553] [1]。[1]：