AEGiS-06IAC: Ensuring patient consent for HIV testing: an evaluation of the impact of policy on practice.

6th International AIDS Conference

San Francisco, California, USA — June 20-23, 1990

Ensuring patient consent for HIV testing: an evaluation of the impact of policy on practice.

Int Conf AIDS 1990 Jun 20-23; 6:332 (abstract no. Th.D.825)
Capkin M, Phipps E, Peacock E; Albert Einstein Medical Center. Philadelphia, Pennsylvania. USA

OBJECTIVES: Our study was designed to evaluate the impact of a stringent hospital policy regarding informed consent on physician ordering of HIV antibody tests. Recognizing the well known practice of ordering HIV antibody tests without consent or counseling, we predicted that physicians who were ordering the tests on patients at low or no risk would be deterred from following the rigorous procedure involved, resulting in a decrease in the number of tests ordered at our institution.

METHODS: We reviewed all inpatient HIV antibody serology records (n=2319) over a twelve month period. Physician data was recorded on 906 patients screened for HIV pre and post implementation of the policy. These data included: physician ordering test, service, date of test, and results. The information was tabulated and analysed using an unpaired t test.

RESULTS: Results show that there was a significant decrease in the number of tests performed monthly, from a mean +/- SD score of 186 +/- 34.5 in the pre policy period to 138 +/- 24.1 in the post policy period (P less than .05). Analysis of testing patterns by service show that, of the hospital departments, only surgery demonstrated an increase in HIV test ordering. This increase was not, however, statistically significant (P greater than .05).

CONCLUSION: Implementation of an institutional policy for HIV antibody testing coupled with requirements for laboratory processing can insure that patients who are tested are informed and counseled. While the original intent of the institutional policy was not to reduce HIV testing, it appears that the decrease in tests performed may be a result of the policy requirements. The trend towards increased testing by one service at our institution underscores the importance of tracking other factors that influence HIV testing. These factors include a more positive attitude towards early detection (in both medical and at-risk populations) along with a growing resentment on the part of health providers about patients' rights superceding their own protection. The danger of relying solely on a quality assurance approach to evaluate the effectiveness of policy on practice is that these important factors will be missed.

Keywords: AEGIS, Evaluation Studies, Public Policy, HIV Antibodies, Dietary Sucrose, Laboratory Techniques and Procedures, Mass Screening, Counseling, Organizational Policy, Learning, Memory, Recognition (Psychology), Ensure, Human, nursing, ICA6

900620
ThD825