title: Maintaining the continuity of HIV-care records for patients transferring care between centers: challenges, workloads, needs and risks.
abstract: With improved life expectancy, the medical records of HIV-infected patients are likely to be transferred repeatedly between HIV caregivers. The challenges, and risk for introducing medical error from incomplete record transfers are poorly understood. We measured number of requests for record transfer, the workload incurred, and explore, using genotypic antiretroviral resistance testing results (GART), the potential risk of incomplete records. Using retrospective database and chart review, we examined all patients followed at the Southern Alberta Clinic between 1 January 2004 and 1 January 2015, and determined how many patients transferred care into and out our program, the associated requests and the workload for record transfer. Using a complete record of all GART tests, the potential importance of absent historic records in current treatment decisions was analyzed. The annual churn rate was 22 ± 3.4%. We received requests for only 70% of patient records who had left our care. Median time for receipt of incoming medical records was 28 days; average clerical time for processing data was 2 hours/record. Of all GART results, 25% exhibited resistance. Of 111 patients with potentially misleading GART results (i.e., documented historical resistance not visible on more recent GART), 34 (30.6%) had moved in from elsewhere. Rigorous maintenance of the continuity of the HIV record is not universally practiced. Resources, costs and logistic challenges as well as a lack of appreciation of risks clearly shown by GART testing, may be relevant barriers. Addressing such issues is pressing as aging and transfers of care are increasingly common.
authors.affiliation: a Southern Alberta HIV Clinic, Alberta Health Services , Calgary , Canada.|b Department of Medicine , University of Calgary , Calgary , Alberta , Canada.|c Department of Microbiology, Immunology, and Infectious Diseases , University of Calgary , Calgary , Canada.
authors.forename: M John
authors.initials: MJ
authors.lastname: Gill
authors.affiliation: a Southern Alberta HIV Clinic, Alberta Health Services , Calgary , Canada.
authors.forename: Meagan
authors.initials: M
authors.lastname: Ody
authors.affiliation: a Southern Alberta HIV Clinic, Alberta Health Services , Calgary , Canada.|d Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Canada.
authors.forename: Tarah
authors.initials: T
authors.lastname: Lynch
authors.affiliation: a Southern Alberta HIV Clinic, Alberta Health Services , Calgary , Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Jessiman-Perreault
authors.affiliation: a Southern Alberta HIV Clinic, Alberta Health Services , Calgary , Canada.|b Department of Medicine , University of Calgary , Calgary , Alberta , Canada.
authors.forename: Hartmut B
authors.initials: HB
authors.lastname: Krentz
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000628:therapy*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010360:Patient Transfer; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents
keywords: Canada; HIV/AIDS; continuity of care; genotypic antiretroviral resistance testing; health records