Use of chart reminders for physicians to promote discussion of advance directives in patients with AIDS.
To determine if use of a physician chart reminder improves the rate of physician-initiated discussion and subsequent completion of advance directives (ADs) in patients with AIDS, a controlled study was conducted with 74 patients with AIDS and ten physicians providing primary care at a university-based hospital clinic. Chart reminders were placed on medical records of intervention patients at each primary care clinic visit for six months. Twelve out of 39 (31%) reminder group patients, but only three out of 35 (9%, p = 0.02) control patients underwent AD discussion with physicians. Further, more subjects in the reminder group completed ADs (28% versus 9%, p = 0.03). Controlling for demographic and clinical factors, only assignment to reminder group was associated with discussion and completion of ADs. Physician-level analysis showed that the effect was physician-dependent. Physician chart reminders are an effective tool for promoting discussion and completion of ADs in patients with AIDS although the effect is physician-dependent.
Walker
N M
NM
Department of Internal Medicine, University of Cincinnati Medical Center, Ohio 45267-0535, USA.
Mandell
K L
KL
Tsevat
J
J
D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology*; D000328:Adult; D016223:Advance Directives; D016022:Case-Control Studies; D006293:Health Promotion; D006801:Humans; D008499:Medical Records; D008505:Medical Staff, Hospital; D011320:Primary Health Care; D017010:Reminder Systems