title: Electronic human immunodeficiency virus (HIV) clinical reminder system improves adherence to practice guidelines among the University of Washington HIV Study Cohort.
abstract: We conducted a prospective study of an electronic clinical reminder system in an academic medical center-based human immunodeficiency virus (HIV) specialty clinic. Published performance indicators were used to examine adherence to HIV practice guidelines before and after its implementation for 1204 patients. More than 90% of patients received CD4 cell count and HIV type 1 (HIV-1) RNA level monitoring every 3-6 months during both time periods, and approximately 80% of patients with a CD4 cell count nadir of <350 cells/mm(3) received highly active antiretroviral therapy. Patients were significantly more likely to receive prophylaxis against Mycobacterium avium complex (hazard ratio, 3.84; 95% confidence interval [CI], 1.58-9.31; P=.003), to undergo annual cervical carcinoma screening (OR, 2.09; 95% CI, 1.04-4.16; P=.04), and to undergo serological screening for Toxoplasma gondii (odds ratio [OR], 1.86; 95% CI, 1.05-3.27; P=.03) and syphilis infection (OR, 3.71; 95% CI, 2.37-5.81; P<.0001). HIV clinical reminders delivered at the time that HIV care is provided were associated with more timely initiation of recommended practices.
authors.affiliation: Department of Medicine, University of Washington, Harborview Medical Center, Box 359931, 325 9th Ave., Seattle, WA 98104, USA. kitahata@u.washington.edu
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillingham
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
authors.forename: Susan E
authors.initials: SE
authors.lastname: Buskin
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jones
authors.forename: Robert D
authors.initials: RD
authors.lastname: Harrington
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Hooton
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D008403:Mass Screening; D009894:Opportunistic Infections / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012367:RNA, Viral / Q000378:metabolism; D017010:Reminder Systems; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral