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Sell J, Chen R, Huber C, Parascando J, Nunez J. Primary Care Provider HIV PrEP Knowledge, Attitudes, and Prescribing Habits: A Cross-Sectional Survey of Late Adopters in Rural and Suburban Practice. J Prim Care Community Health 2023; 14:21501319221147254. [PMID: 36625276 PMCID: PMC9834790 DOI: 10.1177/21501319221147254] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Pre-exposure prophylaxis (PrEP) is a recommended strategy for HIV prevention, yet PrEP prescribing rates in primary care remain low. The aim of this study was to further describe the current knowledge, attitudes, and prescribing behaviors of HIV PrEP in primary care providers with a focus on the perceived barriers and facilitators to PrEP prescribing. METHODS Cross-sectional survey of primary care providers at rural and suburban practices in a large academic institution. RESULTS Survey response rate was 48.0% (n = 134). Most respondents (96.3%) reported little clinical experience in care of persons living with HIV. Respondents self-reported positive attitudes and high overall knowledge of PrEP with low prescribing rates and less comfort with lab testing. More respondents are asked about PrEP by patients (54%) than start conversations about PrEP with patients (39%). Family Physicians and providers 5 to 10 years from completion of training overall reported higher knowledge, attitudes and prescribing behaviors. Lack of PrEP education was identified as the greatest barrier and an electronic medical record order set as the greatest facilitator to prescribing PrEP. CONCLUSIONS With the goal to end the HIV epidemic, PrEP provision in nonurban primary care settings may be an important strategy for increased access to PrEP and reduced HIV transmission. This study, which includes a variety of providers that possess high knowledge, yet low experience prescribing PrEP, likely demonstrates the limitations of interventions which solely focus on provider education. System-based practice solutions, such as order sets, may be needed to target infrequent prescribers of PrEP.
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Affiliation(s)
- Jarrett Sell
- Penn State Health Hershey Medical
Center, Hershey, PA, USA,Jarrett Sell, Department of Family and
Community Medicine, Penn State Health Hershey Medical Center, 500 University
Dr., Hershey, PA 17033, USA.
| | - Rensa Chen
- Penn State Health Hershey Medical
Center, Hershey, PA, USA
| | | | | | - Jonathan Nunez
- Penn State Health Hershey Medical
Center, Hershey, PA, USA
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HIV Testing Uptake According to Opt-In, Opt-Out or Risk-Based Testing Approaches: a Systematic Review and Meta-Analysis. Curr HIV/AIDS Rep 2022; 19:375-383. [PMID: 35829949 PMCID: PMC9508204 DOI: 10.1007/s11904-022-00614-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
Purpose of Review Improving HIV testing uptake is essential to ending the HIV pandemic. HIV testing approaches can be opt-in, opt-out or risk-based. This systematic review examines and compares the uptake of HIV testing in opt-in, opt-out and risk-based testing approaches. Recent Findings There remain missed opportunities for HIV testing in a variety of settings using different approaches: opt-in (a person actively accepts to be tested for HIV), opt-out (a person is informed that HIV testing is routine/standard of care, and they actively decline if they do not wish to be tested for HIV) or risk-based (using risk-based screening tools to focus testing on certain individuals or sub-populations at greater risk of HIV). It is not clear how the approach could impact HIV test uptake when adjusted for other factors (e.g. rapid testing, country-income level, test setting and population tested). Summary We searched four databases for studies reporting on HIV test uptake. In total, 18,238 records were screened, and 150 studies were included in the review. Most studies described an opt-in approach (87 estimates), followed by opt-out (76) and risk-based (19). Opt-out testing was associated with 64.3% test uptake (I2 = 99.9%), opt-in testing with 59.8% (I2 = 99.9%) and risk-based testing with 54.4% (I2 = 99.9%). When adjusted for settings that offered rapid testing, country income level, setting and population tested, opt-out testing had a significantly higher uptake (+ 12% (95% confidence intervals: 3–21), p = 0.007) than opt-in testing. We also found that emergency department patients and hospital outpatients had significantly lower HIV test uptake than other populations. Supplementary Information The online version contains supplementary material available at 10.1007/s11904-022-00614-0.
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Vallée A, Sveltlane D, Trichereau J, Neveu S, Fourn E, Majerholc C, Lesprit P, Mazaux L, Henintsoa SH, Matejczuk G, Vasse M, Zucman D. Electronic medical record alert increases HIV screening rates: the Foch hospital pilot POP-up project. BMC Health Serv Res 2022; 22:784. [PMID: 35710554 PMCID: PMC9202097 DOI: 10.1186/s12913-022-08176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 06/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Despite significant national human immunodeficiency virus (HIV) screening activity, there are persistent delays in screening, and many missed diagnostic opportunities. To facilitate targeted screening, an electronic medical record (EMR) alert reminder was applied in the Foch hospital. Screening rates after implementation were reported. Methods A prospective cohort analysis was performed in Foch Hospital between 24 April 2018 and 4 October 2019 among hospitalized patients born in high HIV prevalence countries and/or having social vulnerability criteria (universal health coverage). From the admissions software, when specific low health coverage was provided and/or high-prevalence country of birth was registered, an electronic alert (EMR alert) appeared on the ward where the patient was hospitalized. The EMR alert database was examined for HIV screening and activity responses from each service of the Hospital. Results Eight thousand one hundred eighty-one alerts were recovered during the period for 1448 patients. 27 services used the EMR alert. Most of the alerts were directly closed (74.4%), 14.5% of the alerts were closed due to doctors declaring that they did not have time to respond. 297 (3.6%) of the 8181 alerts resulted in a prescription of HIV serology corresponding for 20.5% of the patients. Conclusion EMR alert can help to increase the rate of HIV screening in hospital care practice. Through this EMR alert system, HIV screening can be implemented as a common practice like any other medical alternative. Future research should examine the factors influencing physicians’ attitudes to this alert system to improve the HIV screening rate.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France.
| | - Dimi Sveltlane
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Julie Trichereau
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | - Stéphane Neveu
- Département d'Informatique, Hôpital Foch, Suresnes, France
| | - Erwan Fourn
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Philippe Lesprit
- Department of Hygiene and Infectious Disease, Foch Hospital, Suresnes, France
| | - Laurence Mazaux
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - Seheno Harijaona Henintsoa
- Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Foch Hospital, Suresnes, France
| | | | - Marc Vasse
- Service de Biologie Clinique, Hôpital Foch, Suresnes, France
| | - David Zucman
- Department of Internal Medicine, Réseau Ville Hôpital Val de Seine, Foch Hospital, Suresnes, France
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Agustí C, Cunillera O, Almeda J, Mascort J, Carrillo R, Olmos C, Montoliu A, Alberny M, Molina I, Cayuelas L, Casabona J. Efficacy of an electronic reminder for HIV screening in primary healthcare based on indicator conditions in Catalonia (Spain). HIV Med 2022; 23:868-879. [DOI: 10.1111/hiv.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Cristina Agustí
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
| | - Oriol Cunillera
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
| | - Jesús Almeda
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
- Research Support Unit Primary Health General Directorate of Costa de Ponent Catalan Institute of Health (ICS) Cornellà de Llobregat Spain
| | - Juanjo Mascort
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
- Department of Clinical Sciences Faculty of Medicine University of Barcelona (UB) Barcelona Spain
| | - Ricard Carrillo
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
| | - Carmen Olmos
- Health Department Catalan Government Barcelona Spain
| | - Alexandra Montoliu
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Unit of Infections and Cancer ‐ Information and Interventions (UNIC ‐ I&I) Cancer Epidemiology Research Program (CERP) Hospitalet de Llobregat Barcelona Spain
| | - Mireia Alberny
- Medical Management of Primary Care Servicies STI/HIV Area Catalan Institute of Health (ICS) Barcelona Spain
| | - Izarbe Molina
- Association of Family and Community Nursing of Catalonia (AIFiCC) Barcelona Spain
| | - Laia Cayuelas
- Centro de Atención Primaria Casanova Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Barcelona Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine Universitat Autónoma de Barcelona Badalona Spain
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Guzman A, Bring R, Master S, Rosenthal SL, Soren K. Improving the Transition of Adolescents from Disadvantaged Backgrounds from Pediatric to Adult Primary Care Providers. J Pediatr Nurs 2021; 61:269-274. [PMID: 34343766 DOI: 10.1016/j.pedn.2021.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The lack of structured transition interventions for adolescents aging out of pediatric care is associated with poor health outcomes. METHODS We assessed the effectiveness of a transition protocol that aimed to improve the transfer of adolescents to adult primary care. Chart reviews were conducted on 21- and 22-year-old patients seen 18 months before and after protocol implementation. Completion of an adult medicine appointment scheduled within 6 months from the last pediatric visit was the primary outcome of interest. FINDINGS In pre-implementation period, 20.9% of patients versus 39.3% in post-implementation period were transferred. Transfer was higher in patients who had a dedicated transition visit, had a transition order placed, and were tracked during the transfer process. DISCUSSION A transition protocol can increase the number of adolescents who transfer to adult care. Once a patient is ready to transition, a dedicated transition visit is ideal; however, providers should incorporate transition care during any clinical encounter. While an electronic transition order can facilitate appointment scheduling, patient tracking and appointment reminders can help ensure appointment completion. In addition, all clinical staff should receive transition training and clinicians should be frequently reminded about the need to transition their patients. However, even with these efforts to support transition, the majority of patients did not do so, which indicates a continued need to develop and evaluate transition interventions. PRACTICE IMPLICATIONS Implementing a transition protocol in pediatric clinics can improve the transition of adolescents aging out of pediatric care and may diminish gaps in medical care that can be associated with poor health outcomes.
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Affiliation(s)
| | - Rachel Bring
- New York University Grossman School of Medicine, NY, USA.
| | - Samuel Master
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center 622 W., NY, USA; NewYork-Presbyterian Hospital 630 W., NY, USA.
| | - Susan L Rosenthal
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center 622 W., NY, USA.
| | - Karen Soren
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center 622 W., NY, USA; NewYork-Presbyterian Hospital 630 W., NY, USA.
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Kesten JM, Davies CF, Gompels M, Crofts M, Billing A, May MT, Horwood J. Qualitative evaluation of a pilot educational intervention to increase primary care HIV-testing. BMC FAMILY PRACTICE 2019; 20:74. [PMID: 31151414 PMCID: PMC6544931 DOI: 10.1186/s12875-019-0962-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND UK guidelines recommend a 'routine offer of HIV testing' in primary care where HIV diagnosed prevalence exceeds 2 in 1000. However, current primary care HIV testing rates are low. Efforts to increase primary care HIV testing are needed. To examine how an educational intervention to increase HIV testing in general practice was experienced by healthcare professionals (HCPs) and to understand the perceived impacts on HIV testing. METHOD Qualitative interviews with general practitioners (GPs) and nurses 3-months after receiving an educational intervention developed from an adapted version of the Medical Foundation for HIV and Sexual Health (MEDFASH) HIV Testing In Practice (TIPs) online educational tool which included training on HIV associated clinical indicator conditions, why, who, and how to test. The intervention was delivered in 19 high-HIV prevalence general practices in Bristol. 27 semi-structured interviews were conducted across 13 practices with 16 GPs, 10 nurses and the sexual health clinician who delivered the intervention. Transcripts were analysed thematically informed by Normalisation Process Theory. RESULTS HCPs welcomed the opportunity to update their HIV knowledge through a tailored, interactive session. Post-training, HCPs reported increased awareness of HIV indicator conditions, confidence to offer HIV tests and consideration of HIV tests. Continued testing barriers include perceived lack of opportunity. CONCLUSIONS This qualitative study found that HIV education is perceived as valuable in relation to perceived awareness, confidence, and consideration of HIV testing. However, repetition and support from other strategies are needed to encourage HCPs to offer HIV tests. Future interventions should consider using behaviour change theory to develop a complex intervention that addresses not only HCP capability to offer an HIV test, but also issues of opportunity and motivation.
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Affiliation(s)
- Joanna M. Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Charlotte F. Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB UK
| | - Megan Crofts
- Genitourinary medicine, Unity Sexual Health, Bristol Sexual Health Services, Tower Hill, Bristol, BS2 0JD UK
| | - Annette Billing
- Bristol, North Somerset and South Gloucestershire CCG, South Plaza, Marlborough Street, Bristol, BS1 3NX UK
| | - Margaret T. May
- National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jeremy Horwood
- NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Davies CF, Kesten JM, Gompels M, Horwood J, Crofts M, Billing A, Chick C, May MT. Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial. BMC FAMILY PRACTICE 2018; 19:195. [PMID: 30545301 PMCID: PMC6292019 DOI: 10.1186/s12875-018-0880-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND HIV-infected patients often present to primary care several times with HIV-indicator conditions before diagnosis but the opportunity to test by healthcare professionals (HCPs) is frequently missed. Current HIV testing rates in primary care are low and educational interventions to facilitate HCPs to increase testing and awareness of HIV are needed. METHOD We implemented a pilot feasibility stepped-wedged randomised controlled trial of an educational intervention in high HIV prevalence practices in Bristol. The training delivered to HCPs including General Practitioners (GP) aimed to increase HIV testing and included why, who, and how to test. The intervention was adapted from the Medical Foundation for HIV and Sexual Health HIV Testing in Practice (MEDFASH) educational tool. Questionnaires assessed HCP feedback and perceived impacts of the intervention. HIV testing rates were compared between control and intervention practices using 12 monthly laboratory totals. RESULTS 169 HCPs (from 19 practices) received the educational intervention. 127 (75%) questionnaires were completed. Delivery of the intervention was received positively and was perceived as valuable for increasing awareness, confidence and consideration of testing, with HCPs gaining more awareness of HIV testing guidelines. The main pre-training HIV testing barrier reported by GPs was the patient not considering themselves at risk, whilst for nurses it was a concern about embarrassing or offending the patient. Most HCPs reported the intervention addressed these barriers. The HIV testing rate increased more in the control than in the intervention practices: mean difference 2.6 (95% CI 0.5,4.7) compared with 1.9 (- 0.5,4.3) per 1000 patients, respectively. The number of HIV tests across all practices increased from 1154 in the first 6 months to 1299 in the second 6 months, an annual increase in testing rate of 2.0 (0.7,3.4) from 16.3 to 18.3 per 1000 patients. CONCLUSION There was a small increase in HIV testing rates over the study period, but this could not be attributed to the educational intervention. More effective and sustainable programmes tailored to each practice context are needed to change testing culture and HCP behaviour. Repeated training, supported by additional measures, such as testing prompts, may be needed to influence primary care HIV testing.
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Affiliation(s)
- Charlotte F Davies
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Jeremy Horwood
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England
| | - Megan Crofts
- Genitourinary medicine, Unity Sexual Health, Bristol Sexual Health Services, Tower Hill, Bristol, BS2 0JD, UK.
| | - Annette Billing
- NHS Bristol, North Somerset and South Gloucestershire CCG, South Plaza, Marlborough Street, Bristol, BS1 3NX, UK.
| | - Charlotte Chick
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Margaret T May
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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8
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Branson BM, Chavez PR, Hanscom B, Greene E, McKinstry L, Buchacz K, Beauchamp G, Gamble T, Zingman BS, Telzak E, Naab T, Fitzpatrick L, El-Sadr WM. Expanding Hospital Human Immunodeficiency Virus Testing in the Bronx, New York and Washington, District of Columbia: Results From the HPTN 065 Study. Clin Infect Dis 2018; 66:1581-1587. [PMID: 29186421 PMCID: PMC5930256 DOI: 10.1093/cid/cix1053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/23/2017] [Indexed: 01/20/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) testing is critical for both HIV treatment and prevention. Expanding testing in hospital settings can identify undiagnosed HIV infections. Methods To evaluate the feasibility of universally offering HIV testing during emergency department (ED) visits and inpatient admissions, 9 hospitals in the Bronx, New York and 7 in Washington, District of Columbia (DC) undertook efforts to offer HIV testing routinely. Outcomes included the percentage of encounters with an HIV test, the change from year 1 to year 3, and the percentages of tests that were HIV-positive and new diagnoses. Results From 1 February 2011 to 31 January 2014, HIV tests were conducted during 6.5% of 1621016 ED visits and 13.0% of 361745 inpatient admissions in Bronx hospitals and 13.8% of 729172 ED visits and 22.0% of 150655 inpatient admissions in DC. From year 1 to year 3, testing was stable in the Bronx (ED visits: 6.6% to 6.9%; inpatient admissions: 13.0% to 13.6%), but increased in DC (ED visits: 11.9% to 15.8%; inpatient admissions: 19.0% to 23.9%). In the Bronx, 0.4% (408) of ED HIV tests were positive and 0.3% (277) were new diagnoses; 1.8% (828) of inpatient tests were positive and 0.5% (244) were new diagnoses. In DC, 0.6% (618) of ED tests were positive and 0.4% (404) were new diagnoses; 4.9% (1349) of inpatient tests were positive and 0.7% (189) were new diagnoses. Conclusions Hospitals consistently identified previously undiagnosed HIV infections, but universal offer of HIV testing proved elusive.
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Affiliation(s)
- Bernard M Branson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett Hanscom
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elizabeth Greene
- Leadership and Operations Center, HIV Prevention Trials Network, FHI, Durham, North Carolina
| | - Laura McKinstry
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Geetha Beauchamp
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Theresa Gamble
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Barry S Zingman
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx
| | | | - Tammey Naab
- Howard University Hospital, Washington, District of Columbia
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Care continuum entry interventions: seek and test strategies to engage persons most impacted by HIV within the United States. AIDS 2018; 32:407-417. [PMID: 29381558 DOI: 10.1097/qad.0000000000001733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
: The current review re-conceptualizes seek and test strategies, particularly given the changing importance of HIV testing as care continuum entry for persons irrespective of their HIV status. Care continuum entry advances previous seek and test strategies for client engagement with two next-generation functions: use of testing to engage (or re-engage) HIV negative clients in preexposure prophylaxis (PrEP) care; and testing individuals who may already be known positives for care continuum re-entry. We review existing seek and test strategies for most impacted community members with a goal of optimizing care continuum entry as we move towards HIV transmission elimination. These strategies are context, sub-group, community and epidemic-specific. This review is timely, given the initiation of routine PrEP care, which shifts and broadens our conceptualization of care continuum entry triggered by the HIV testing event. In addition, as the epidemic becomes more concentrated, focusing on re-engagement of HIV-infected persons becomes increasingly important given that transmission events involve both those acutely and newly infected as well as the large numbers who may not be virally suppressed. We start with examination of routine testing in healthcare settings, emphasizing its potential role in re-engagement for persons out of care. Subsequently, we describe risk-based testing to identify key populations. We then review network-based approaches and their impact on the epidemic. We close with future directions for individual and combination care continuum entry strategies most relevant to elimination of HIV transmission in the United States.
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Kershaw C, Taylor JL, Horowitz G, Brockmeyer D, Libman H, Kriegel G, Ngo L. Use of an electronic medical record reminder improves HIV screening. BMC Health Serv Res 2018; 18:14. [PMID: 29316919 PMCID: PMC5761195 DOI: 10.1186/s12913-017-2824-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 12/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background More than 1 in 7 patients with human immunodeficiency virus (HIV) infection in the United States are unaware of their serostatus despite recommendations of US agencies that all adults through age 65 be screened for HIV at least once. To facilitate universal screening, an electronic medical record (EMR) reminder was created for our primary care practice. Screening rates before and after implementation were assessed to determine the impact of the reminder on screening rates. Methods A retrospective cohort analysis was performed for patients age 18–65 with visits between January 1, 2012-October 30, 2014. EMR databases were examined for HIV testing and selected patient characteristics. We evaluated the probability of HIV screening in unscreened patients before and after the reminder and used a multivariable generalized linear model to test the association between likelihood of HIV testing and specific patient characteristics. Results Prior to the reminder, the probability of receiving an HIV test for previously unscreened patients was 15.3%. This increased to 30.7% after the reminder (RR 2.02, CI 1.95–2.09, p < 0.0001). The impact was most significant in patients age 45–65. White race, English as primary language, and higher median household income were associated with lower likelihoods of screening both before and after implementation (RR 0.68, CI 0.65–0.72; RR 0.74, CI 0.67–0.82; RR 0.84, CI 0.80–0.88, respectively). Conclusions The EMR reminder increased rates of HIV screening twofold in our practice. It was most effective in increasing screening rates in older patients. Patients who were white, English-speaking, and had higher incomes were less likely to be screened for HIV both before and after the reminder.
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Affiliation(s)
- Colleen Kershaw
- Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA, 02215, USA.
| | - Jessica L Taylor
- Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2, Boston, MA, 02118, USA
| | - Gary Horowitz
- Department of Pathology, Tufts Medical Center, Biewend Building 3, 800 Washington St, Boston, MA, 02111, USA
| | - Diane Brockmeyer
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Howard Libman
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Gila Kriegel
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
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Tan K, Black BP. A Systematic Review of Health Care Provider-Perceived Barriers and Facilitators to Routine HIV Testing in Primary Care Settings in the Southeastern United States. J Assoc Nurses AIDS Care 2017; 29:357-370. [PMID: 29331504 DOI: 10.1016/j.jana.2017.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
Despite efforts to improve HIV screening and testing, many primary care settings do not follow established guidelines. The purpose of our systematic review was to describe health care providers' perceived barriers and facilitators to testing for HIV at poorly used/novel testing sites in the southeastern United States. PubMed, CINAHL, and Embase databases were searched for peer-reviewed studies of providers' perceived barriers and facilitators to routine HIV testing from January 2016 to April 2017 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of 708 papers retrieved, 12 met inclusion criteria and were analyzed. Barriers to HIV testing in primary care existed at the societal, organizational, and individual levels. Providers need continuing sexual health education, including HIV and federal guideline updates, and students should have clinical experiences to supplement knowledge about sexual health. Clinic protocols should be updated to meet current policy guidelines.
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12
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Domínguez-Berjón MF, Pichiule-Castañeda M, García-Riolobos MC, Esteban-Vasallo MD, Arenas-González SM, Morán-Arribas M, Verdejo-Ortés J, Zoni AC, Álvarez-Castillo MC, Astray J. A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project). J Eval Clin Pract 2017; 23:1408-1414. [PMID: 28971579 DOI: 10.1111/jep.12813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. METHODS We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. RESULTS Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies. CONCLUSION Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.
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Affiliation(s)
| | | | | | | | | | | | - José Verdejo-Ortés
- Public Health Directorate, Madrid Regional Health Authority, Madrid, Spain
| | - Ana Clara Zoni
- Public Health Directorate, Madrid Regional Health Authority, Madrid, Spain
| | | | - Jenaro Astray
- Public Health Directorate, Madrid Regional Health Authority, Madrid, Spain
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13
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Espinel M, Belza MJ, Cabeza-de-Vaca C, Arranz B, Guerras JM, Garcia-Soltero J, Hoyos J. Indicator condition based HIV testing: Missed opportunities for earlier diagnosis in men who have sex with men. Enferm Infecc Microbiol Clin 2017; 36:465-471. [PMID: 28993068 DOI: 10.1016/j.eimc.2017.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Contact with the healthcare system by a sample of seropositive men who have sex with men (MSM) prior to their HIV diagnosis are analysed, and missed opportunities (MO) for an earlier HIV diagnosis are identified. METHODOLOGY Between 2012-2013, an online survey was conducted among HIV-positive MSM, mainly recruited from gay websites. Those who were diagnosed with HIV between 2010-2013 were analysed. MO were defined as episodes prior to the HIV diagnosis in which the healthcare system was contacted due to an indicator condition of HIV infection and the test was not suggested. The proportion of missed opportunities were compared according to the type of indicator condition, the department consulted and the healthcare professional's knowledge that the patient was MSM. RESULTS Overall, 639 participants (66% of 966) reported 1,145 episodes with some indicator condition, the majority of these being identified in primary care (n=527; 46%). The highest percentage of MOs is also observed in primary care (63%). Although the indicator condition with the highest number of MOs was STIs (n=124), the highest percentage of MOs was observed in consultations due to diarrhoea with no known cause (69.8%). The percentage of MOs when the doctor knew that the patient was MSM was 40 vs. 70% when the doctor did not know. CONCLUSION The majority of HIV-positive MSM analysed in this study went to healthcare services for HIV-infection indicator conditions prior to their HIV diagnosis. Primary care was the most-frequently-visited department and is also where the most opportunities were missed to perform an HIV test, even when it was known that the patient was a MSM.
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Affiliation(s)
| | - María José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | | | - Beatriz Arranz
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - Juan Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | | | - Juan Hoyos
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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14
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Agustí C, Martín-Rabadán M, Zarco J, Aguado C, Carrillo R, Codinachs R, Carmona JM, Casabona J. [Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin]. Aten Primaria 2017. [PMID: 28629887 PMCID: PMC6836963 DOI: 10.1016/j.aprim.2017.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objetivos Estimar la prevalencia de la infección por VIH en pacientes diagnosticados con una condición indicadora (CI) para el VIH y/o que habían tenido una conducta de riesgo para su adquisición y/o que provenían de países con elevada prevalencia. Determinar la aceptabilidad y viabilidad de ofrecer la prueba del VIH basada en CI y criterios conductuales y de origen en atención primaria (AP). Diseño Estudio transversal en una muestra de conveniencia. Emplazamiento Seis centros de AP en España. Participantes Los criterios de inclusión fueron: pacientes entre 16 y 65 años que presentaban al menos una de las CI propuestas y/o al menos uno de los criterios conductuales y/o de origen propuestos. Participaron 388 pacientes. Intervención Se ofreció la serología del VIH a todos los pacientes que cumplían con los criterios de inclusión. Mediciones principales Descripción de la frecuencia de CI, criterios conductuales y de origen. Prevalencia de infección por VIH. Nivel de aceptabilidad y viabilidad de la oferta de la prueba del VIH basada en criterios conductuales y de origen y CI. Resultados Un total de 174 pacientes presentaron una CI (44,84%). El criterio conductual más común fue: haber mantenido relaciones sexuales desprotegidas alguna vez en la vida con personas que desconocían su estado serológico para el VIH (298; 76,8%). Se diagnosticaron 4 pacientes VIH+ (1,03%). Todos presentaban una CI y eran hombres que mantenían sexo con hombres. El nivel de aceptabilidad en AP fue elevada. Conclusiones Ofrecer la prueba del VIH a pacientes con CI y criterios conductuales es viable y efectiva en AP.
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Affiliation(s)
- Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), España.
| | | | | | | | - Ricard Carrillo
- Centre d'Atenció Primària Florida Sud, Hospitalet de Llobregat, Barcelona, España; Societat Catalana de Medicina Familiar i Comunitària (CAMFiC), Barcelona, España
| | | | - Jose Manuel Carmona
- Centre d'Atenció Primària Castellar del Vallès, Castellar del Vallès, Barcelona, España
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), España; Departament de Pediatria, Obstetricia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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15
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Gervès-Pinquié C, Daumas-Yatim F, Lalloué B, Girault A, Ferrua M, Fourcade A, Lemare F, Dipalma M, Minvielle E. Impacts of a navigation program based on health information technology for patients receiving oral anticancer therapy: the CAPRI randomized controlled trial. BMC Health Serv Res 2017; 17:133. [PMID: 28193214 PMCID: PMC5307879 DOI: 10.1186/s12913-017-2066-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 01/31/2017] [Indexed: 02/06/2023] Open
Abstract
Background The emergence of oral delivery in cancer therapeutics is expected to result in an increased need for better coordination between all treatment stakeholders, mainly to ensure adequate treatment delivery to the patient. There is significant interest in the nurse navigation program’s potential to improve transitions of care by improving communication between treatment stakeholders and by providing personalized organizational assistance to patients. The use of health information technology is another strategy aimed at improving cancer care coordination that can be combined with the NN program to improve remote patient follow-up. However, the potential of these two strategies combined to improve oral treatment delivery is limited by a lack of rigorous evidence of actual impact. Methods/design We are conducting a large scale randomized controlled trial designed to assess the impact of a navigation program denoted CAPRI that is based on two Nurse Navigators and a web portal ensuring coordination between community and hospital as well as between patients and navigators, versus routine delivery of oral anticancer therapy. The primary research aim is to assess the impact of the program on treatment delivery for patients with metastatic cancer, as measured by Relative Dose Intensity. The trial involves a number of other outcomes, including tumor response, survival, toxic side effects, patient quality of life and patient experience An economic evaluation adopting a societal perspective will be conducted, in order to estimate those health. care resources’ used. A parallel process evaluation will be conducted to describe implementation of the intervention. Discussion If the CAPRI program does improve treatment delivery, the evidence on its economic impact will offer important knowledge for health decision-makers, helping develop new follow-up services for patients receiving oral chemotherapy and/or targeted therapy. The process evaluation will determine the best conditions in which such a program might be implemented. Trial registration NCT 02828462. Registered 29 June 2016.
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Affiliation(s)
- Chloé Gervès-Pinquié
- Equipe d'Accueil Management des Organisations de Santé, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard, 35043, Rennes, France. .,Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France.
| | - Fatima Daumas-Yatim
- Equipe d'Accueil Management des Organisations de Santé, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard, 35043, Rennes, France.,Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France
| | - Benoît Lalloué
- Equipe d'Accueil Management des Organisations de Santé, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard, 35043, Rennes, France.,Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France
| | - Anne Girault
- Equipe d'Accueil Management des Organisations de Santé, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard, 35043, Rennes, France
| | - Marie Ferrua
- Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France
| | - Aude Fourcade
- Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France
| | - François Lemare
- Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France
| | - Mario Dipalma
- Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France
| | - Etienne Minvielle
- Equipe d'Accueil Management des Organisations de Santé, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon-Bernard, 35043, Rennes, France.,Gustave Roussy, 114 Rue Edouard Vaillant - 1er étage zone B, 94805, Villejuif, France
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Abstract
The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm (AAA) screening decreased related mortality by close to half. Despite the simplicity of screening, research suggests poor adherence to the recommended AAA screening guidelines. Using the quality improvement plan-study-do-act cycle, we retrospectively established poor adherence to AAA screening and poor documentation of smoking history in our resident clinic. An electronic reminder was prospectively implemented into our electronic medical record (EMR) with the goal of improving screening rates. After 1 year, a retrospective chart review was conducted. Comparisons of the pre- and post-electronic reminder intervention data were made using chi-square tests and odds ratios (OR). The purposeful AAA screening rate improved 27.8% during the intervention, 40.3% (95% confidence interval [CI]: 28.6-52.0%) versus 12.5% (95% CI: 3.1-21.9%), p = .002, suggesting patients were more likely to be screened as a result of the electronic reminder, OR = 4.73 (95% CI: 1.77-12.65). This improvement translates to a large effect size, Cohen's d = 0.86 (95% CI: 0.31-1.40). Electronic reminders are a simple EMR addition that can provide evidence-based education while improving adherence rates with preventive health screening measures.
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17
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Tillison AS, Avery AK. Evaluation of the Impact of Routine HIV Screening in Primary Care. J Int Assoc Provid AIDS Care 2016; 16:18-22. [PMID: 27596961 DOI: 10.1177/2325957416666677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Since 2006, numerous testing initiatives have been launched across the United States to increase the number of individuals who know their HIV status. These initiatives are often venue based and reported in a variety of settings. However, the effectiveness of these initiatives has not been evaluated to determine if patients were identified earlier in the course of disease or would not have been otherwise tested. In 2010, a publicly funded teaching hospital implemented an electronic medical record prompt to improve the rate of routine HIV screening and diagnosis, focusing on primary care office visits. Both sex and CD4 count were found to be significantly related to being newly diagnosed after the intervention. Routine testing in primary care is an effective strategy to diagnose patients earlier in disease progression, particularly men who might otherwise not be tested and thus would remain undiagnosed until developing symptoms from advanced disease.
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Affiliation(s)
| | - Ann Keltner Avery
- 2 MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
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18
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Wells S, Rafter N, Eggleton K, Turner C, Huang Y, Bullen C. Using run charts for cardiovascular disease risk assessments in general practice. J Prim Health Care 2016; 8:172-8. [PMID: 27477560 DOI: 10.1071/hc15030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Run charts are quality improvement tools. AIM To investigate the feasibility and acceptability of run charts displaying weekly cardiovascular disease (CVD) risk assessments in general practice and assess their impact on CVD risk assessments. METHODS A controlled non-randomised observational study in nine practices using run charts and nine control practices. We measured the weekly proportion of eligible patients with completed CVD risk assessments for 19 weeks before and after run charts were introduced into intervention practices. A random coefficients model determined changes in CVD risk assessment rates (slope) from pre- to post- intervention by aggregating and comparing intervention and control practices' mean slopes. We interviewed staff in intervention practices about their use of run charts. RESULTS Seven intervention practices used their run chart; six consistently plotting weekly data for >12 weeks and positioning charts in a highly visible place. Staff reported that charts were easy to use, a visual reminder for ongoing team efforts, and useful for measuring progress. There were no significant differences between study groups: the mean difference in pre- to post-run chart slope in the intervention group was 0.03% more CVD risk assessments per week; for the control group the mean difference was 0.07%. The between group difference was 0.04% per week (95% CI: -0.26 to 0.35, P = 0.77). DISCUSSION Run charts are feasible in everyday general practice and support team processes. There were no differences in CVD risk assessment between the two groups, likely due to national targets driving performance at the time of the study.
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Affiliation(s)
- Susan Wells
- 1 Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | | | - Kyle Eggleton
- 3 Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Catherine Turner
- 4 Population Health Strategist/Analyst, Northland Primary Health Organisations
| | - Ying Huang
- 1 Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Chris Bullen
- 5 Director, The National Institute for Health Innovation (NIHI), School of Population Health, University of Auckland, New Zealand
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Joore IK, van Roosmalen SL, van Bergen JE, van Dijk N. General practitioners' barriers and facilitators towards new provider-initiated HIV testing strategies: a qualitative study. Int J STD AIDS 2016; 28:459-466. [PMID: 27207253 PMCID: PMC5347361 DOI: 10.1177/0956462416652274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). UK guidelines recommend performing a ‘routine offer of HIV testing’ in primary care where HIV prevalence exceeds 2 in 1000. Implementation of new provider-initiated HIV testing strategies in general practice is limited, while the numbers of undiagnosed and late for care HIV patients remain high. We have explored Dutch general practitioners’ barriers to and facilitators of both strategies. We combined semi-structured in-depth interviews with focus groups. Nine general practitioners – key informants of sexually transmitted infection/HIV prevention and control – were selected for the interviews. Additionally, we organised focus groups with a broad sample of general practitioners (n = 81). Framework analysis was used to analyse the data. Various barriers were found, related to (1) the content of the guidelines (testing the right group and competing priorities in general practice), (2) their organisational implementation (lack of time, unclear when to repeat the HIV test and overlong list of ICs) and (3) the patient population (creating fear among patients, stigmatising them and fear regarding financial costs). Multiple general practitioners stated that performing a sexual risk assessment of patients is important before applying either strategy. Also, they recommended implementing the IC-guided approach only in high-prevalence areas and combining HIV tests with other laboratory blood tests. General practitioners tend to cling to old patterns of risk-based testing. Promoting awareness of HIV testing and educating general practitioners about the benefits of new provider-initiated HIV testing strategies is important for the actual uptake of HIV testing.
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Affiliation(s)
- Ivo K Joore
- 1 Department of General Practice/Family Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Sanne Lc van Roosmalen
- 2 Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | - Jan Eam van Bergen
- 1 Department of General Practice/Family Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.,3 STI AIDS Netherlands (Soa Aids Nederland), Amsterdam, Netherlands.,4 Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Nynke van Dijk
- 1 Department of General Practice/Family Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
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20
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Agustí C, Montoliu A, Mascort J, Carrillo R, Almeda J, Elorza JM, Aragón M, Casabona J. Missed opportunities for HIV testing of patients diagnosed with an indicator condition in primary care in Catalonia, Spain. Sex Transm Infect 2016; 92:387-92. [PMID: 26888659 DOI: 10.1136/sextrans-2015-052328] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/23/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of HIV testing among patients diagnosed with an indicator condition (IC) for HIV, seen in primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients. DESIGN Cross-sectional and population-based study in patients aged between 16 and 65 diagnosed with an IC within PC in Catalonia. METHODS Data used in this study were extracted from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP). All participants registered in SIDIAP from 1 January 2010 to 31 August 2012 and with a diagnosis of an IC were screened to identify those with an HIV test within the following 4 months. RESULTS 99 426 patients were diagnosed with an IC during the study period. In these patients, there were 102 647 episodes in which at least one IC was diagnosed. An HIV test was performed within 4 months in only 18 515 of the episodes in which an IC was diagnosed (18.5%). The prevalence of HIV infection was 1.46%. Women (OR 1.35, 95% CI 1.30 to 1.39), people aged 50 or over (OR 2.85, 95% CI 2.69 to 3.00) and patients having a single IC (OR 3.59. 95% CI 3.20 to 4.03) had the greatest odds of not having an HIV test. CONCLUSIONS The study highlights the persistence of missed opportunities for HIV testing within PC in Catalonia. Urgent engagement with PC professionals is required in order to increase HIV testing and prevent late HIV diagnoses.
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Affiliation(s)
- Cristina Agustí
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT)-Public Health Agency of Catalonia (ASPC), Badalona, Spain CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Alexandra Montoliu
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT)-Public Health Agency of Catalonia (ASPC), Badalona, Spain CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Juanjo Mascort
- Catalan Society of Family and Community Medicine (CAMFiC), Barcelona, Spain Sociedad Española de Medicina Familiar y Comunitaria (semFYC), Barcelona, Spain Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona (UB), Barcelona, Spain
| | - Ricard Carrillo
- Catalan Society of Family and Community Medicine (CAMFiC), Barcelona, Spain
| | - Jesús Almeda
- Research Support Unit, Primary Care Directorate of Costa de Ponent, Catalan Health Institute, Cornellà de Llobregat, Spain IDIAP Jordi Gol, Barcelona, Spain
| | | | | | - Jordi Casabona
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT)-Public Health Agency of Catalonia (ASPC), Badalona, Spain CIBER Epidemiología y Salud Pública, Barcelona, Spain Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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McGuire R, Moore E. Using a configurable EMR and decision support tools to promote process integration for routine HIV screening in the emergency department. J Am Med Inform Assoc 2015; 23:396-401. [PMID: 26338216 DOI: 10.1093/jamia/ocv031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 03/15/2015] [Indexed: 11/12/2022] Open
Abstract
Given the clinical and public health benefits of routine Human Immunodeficiency Virus (HIV) testing in the emergency department (ED) and Centers for Disease Control and Prevention recommendations, Maricopa Medical Center, as part of Maricopa Integrated Health System, started Test, Educate, Support, and Treat Arizona (TESTAZ) and became the first and, to-date, only hospital in Arizona to implement routine, non-targeted, opt-out, rapid HIV screening in the ED. The authors describe the implementation of a universal, routine, opt-out HIV screening program in the adult ED of an urban safety-net hospital serving under-served populations, including the uninsured and under-insured. Through a controlled and collaborative process, the authors integrated custom documentation elements specific to HIV screening into the triage/intake process, implemented and utilized clinical decision support tools to guide clinicians in each step of the process, and used electronic data collection and reporting to drive new screening protocols that led to a significant increase in overall HIV testing rates.
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Affiliation(s)
- Robert McGuire
- Department of Information Technology, Maricopa Integrated Health System, 2601 E Roosevelt St, Phoenix, AZ 85008-4973, USA
| | - Eric Moore
- Grants and Research Department, Maricopa Integrated Health System, Phoenix, AZ, USA
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Portela MC, Pronovost PJ, Woodcock T, Carter P, Dixon-Woods M. How to study improvement interventions: a brief overview of possible study types. Postgrad Med J 2015; 91:343-54. [PMID: 26045562 PMCID: PMC4484358 DOI: 10.1136/postgradmedj-2014-003620rep] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Peter J Pronovost
- Departments of Anesthesiology, Critical Care Medicine, and Surgery, Armstrong Institute for Patient Safety and Quality, School of Medicine, and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Woodcock
- NIHR CLAHRC for Northwest London, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Pam Carter
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
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Portela MC, Pronovost PJ, Woodcock T, Carter P, Dixon-Woods M. How to study improvement interventions: a brief overview of possible study types. BMJ Qual Saf 2015; 24:325-36. [PMID: 25810415 PMCID: PMC4413733 DOI: 10.1136/bmjqs-2014-003620] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/16/2015] [Indexed: 12/16/2022]
Abstract
Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK Department of Health Administration and Planning, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Peter J Pronovost
- Departments of Anesthesiology, Critical Care Medicine, and Surgery, Armstrong Institute for Patient Safety and Quality, School of Medicine, and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Woodcock
- NIHR CLAHRC for Northwest London, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Pam Carter
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Social Science Applied to Healthcare Research (SAPPHIRE) Group, Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
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Abstract
Sexually transmitted infections (STIs) are common and costly, in part because they are asymptomatic and result in serious complications. Primary care clinicians can easily diagnose and effectively treat most STIs. Clinicians should screen patients for STIs based on high-risk behaviors, and consult with local public health officials to adapt national screening guidelines to local epidemiology. Clinical encounters involving STI screening are opportunities to counsel patients on risk behaviors, and vaccinate against human papillomavirus and hepatitis B. Electronic health records and mobile phone apps show promise for improving the clinical care of STIs.
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