CLINICAL PRACTICE

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Efficacy of a Clinical Decision-Support System in an HIV Practice

 

Data to support improved patient outcomes from clinical decision-support systems (CDSSs) are lacking in HIV care. As a result, a study published in Annals of Internal Medicine (2012; 157:757-766) was performed to test the efficacy of a CDSS in improving HIV outcomes in an outpatient clinic. The investigation was a randomized, controlled trial, which included HIV care providers and their patients.

 

For the study, computer alerts were generated for virologic failure (HIV RNA level >400 copies/mL after a previous HIV RNA level <400 copies/mL), evidence of suboptimal follow-up, and 11 abnormal laboratory test results. Providers received interactive computer alerts, facilitating appointment rescheduling and repeated laboratory testing, for half of their patients and static alerts for the other half. The primary end point was change in CD4 cell count. Other end points included time to clinical event, 6-month suboptimal follow-up, and severe laboratory toxicity.

 

In terms of results, 33 HIV care providers followed 1,011 patients with HIV. In the intervention group, the mean increase in CD4 cell count was greater (0.0053 vs. 0.0032 x109 cells/L per month; difference, 0.0021 x109 cells/L per month [95% CI, 0.0001 to 0.004]; P=0.040) and the rate of 6-month suboptimal follow-up was lower (20.6 vs. 30.1 events per 100 patient-years; P=0.022) than those in the control group. Median time to next scheduled appointment was shorter in the intervention group than in the control group after a suboptimal follow-up alert (1.71 vs. 3.48 months; P<0.001) and after a toxicity alert (2.79 vs. >6 months; P=0.072). More than 90% of providers supported adopting the CDSS as part of standard care.

 

According to the authors, CDSS using interactive provider alerts improved CD4 cell counts and clinic follow-up for patients with HIV and that wider implementation of such systems can provide important clinical benefits.

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