How to improve the quality of a disease management program for HIV-infected patients using  a computerized data system. The Saint-Antoine Orchestra program.
OBJECTIVE
The emergence of non-AIDS-related events in the HIV-infected population experiencing a longer life expectancy implies the implementation of a comprehensive approach of HIV clinical management through better access to care, prevention, and early diagnosis of co-morbidities.


METHODS
The Orchestra program is a computer-assisted HIV care and support tool implemented since December 2004 in the outpatient clinic of a University Hospital set in Paris, France. The intervention aims at improving access to HIV information care and support specifically targeted five areas of actions: cardiovascular risk factors; gynecological follow-up; anti-hepatitis B virus (HBV) vaccine coverage; sexuality and prevention of sexually transmitted infections; and compliance to antiretrovirals. The impact of this program was examined prospectively on a "before-after" basis after a two-year implementation.


RESULTS
In the two-year period, 1717 patients were regularly followed. The level of the database information significantly increased in time (low density lipoprotein (LDL) cholesterol and glycemia were informed in 74% of patients at inclusion versus 95% at two years, and 83% versus 97%, p < 0.001, respectively). The number of targeted interventions was also higher. For eligible women, papanicolaou smears and mammography were prescribed in 52% of cases after intervention, versus 44% at inclusion, p0.04 and 83% versus 50%, p < 0.001, respectively. Indicators of care eventually improved significantly. Initially 72% non-adherent patients declared to be adherent after the intervention ( p < 0.001) and 67% of patients with initial LDL-hypercholesterolemia normalized their LDL level within two years ( p < 0.001).


CONCLUSIONS
The Orchestra program has provided a unique opportunity to assess and improve prevention and management of co-morbidities in HIV patients.
Fonquernie
F
F
AP-HP, Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, Paris, France. laurent.fonquernie@sat.aphp.fr
Lacombe
K
K
Vincensini
J P
JP
Boccara
F
F
Clozel
S
S
Ayouch Boda
A
A
Bollens
D
D
Campa
P
P
Pacanowski
J
J
Meynard
J L
JL
Meyohas
M C
MC
Girard
P M
PM
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000517:prevention & control; D000328:Adult; D015897:Comorbidity; D003194:Computer-Assisted Instruction / Q000379:methods; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000592:standards*; D012306:Risk