title: HIV Provider Documentation and Actions Following Patient Reports of At-risk Behaviors and Conditions When Identified by a Web-Based Point-of-Care Assessment.
abstract: We compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. During the study period (1 January 2006-15 October 2010), 2289 PRO assessments were completed by HIV-infected patients. Comparing the 8 months before versus after feedback implementation, providers were more likely to document depression (74% before vs. 87% after feedback, p = 0.02) in patients with moderate-to-severe depression (n = 317 assessments), at-risk alcohol use (41 vs. 64%, p = 0.04, n = 155) and substance use (60 vs. 80%, p = 0.004, n = 212). Providers were less likely to incorrectly document good adherence among patients with inadequate adherence after feedback (42 vs. 24%, p = 0.02, n = 205). While PRO feedback of depression and adherence were followed by increased provider intervention, other domains were not. Further investigation of factors associated with the gap between awareness and intervention are needed in order to bridge this divide.
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA. hcrane@uw.edu.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Tufano
authors.affiliation: Department of Medicine, Group Health Cooperative, Seattle, WA, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.affiliation: Chair of Health Services, Policy and Practice, Brown University, Providence, RI, USA.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Tyler D
authors.initials: TD
authors.lastname: Brown
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Davis
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Laurie F
authors.initials: LF
authors.lastname: Smith
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Lober
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: McReynolds
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Shireesha
authors.initials: S
authors.lastname: Dhanireddy
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Harrington
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Carla V
authors.initials: CV
authors.lastname: Rodriguez
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Nance
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Joseph A C
authors.initials: JAC
authors.lastname: Delaney
authors.affiliation: Fenway Health, Boston, MA, USA.|University of Miami, Miami, FL, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.affiliation: Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98104, USA.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Fredericksen
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D003625:Data Collection / Q000379:methods*; D003863:Depression / Q000453:epidemiology; D004282:Documentation; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D020407:Internet; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D019095:Point-of-Care Systems; D012309:Risk-Taking; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Alcohol use; Depression; Patient reported outcomes; Sexual risk behavior; Substance use